- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,540.10 / $4,540.10 / $4,540.10
| Facility | | $4,540.10 | $4,540.10 | $4,540.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,540.10 / $4,898.64 / $7,890.11
| Professional | | $4,540.10 | $4,898.64 | $7,890.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,593.50 / $17,641.90 / $48,813.24
| Facility | | $5,593.50 | $17,641.90 | $48,813.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,699.85 / $7,453.95 / $10,147.45
| Professional | | $4,699.85 | $7,453.95 | $10,147.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,028.94 / $13,417.97 / $17,279.81
| Facility | | $11,028.94 | $13,417.97 | $17,279.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,804.10 / $8,734.44 / $8,734.44
| Professional | | $6,804.10 | $8,734.44 | $8,734.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,010.34 / $7,503.37 / $7,503.37
| Facility | | $6,010.34 | $7,503.37 | $7,503.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,477.46 / $7,503.37 / $12,466.13
| Professional | | $5,477.46 | $7,503.37 | $12,466.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,413.11 / $8,413.11 / $8,833.77
| Professional | | $8,413.11 | $8,413.11 | $8,833.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,957.06 / $6,957.06 / $6,957.06
| Professional | | $6,957.06 | $6,957.06 | $6,957.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,828.63 / $48,813.24 / $48,813.24
| Facility | | $21,828.63 | $48,813.24 | $48,813.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,058.98 / $5,554.37 / $10,147.45
| Professional | | $4,058.98 | $5,554.37 | $10,147.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,680.64 / $5,554.37 / $9,420.65
| Professional | | $4,680.64 | $5,554.37 | $9,420.65 |