- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,461.96 / $4,099.67 / $7,588.69
| Facility | | $3,461.96 | $4,099.67 | $7,588.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,461.96 / $4,561.59 / $5,939.32
| Professional | | $3,461.96 | $4,561.59 | $5,939.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,420.65 / $9,609.06 / $18,841.30
| Facility | | $9,420.65 | $9,609.06 | $18,841.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,543.68 / $6,543.68 / $15,841.61
| Professional | | $6,543.68 | $6,543.68 | $15,841.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,299.36 / $7,848.77 / $7,848.77
| Facility | | $7,299.36 | $7,848.77 | $7,848.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,848.77 / $7,848.77 / $7,848.77
| Professional | | $7,848.77 | $7,848.77 | $7,848.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,503.37 / $7,503.37 / $7,503.37
| Facility | | $7,503.37 | $7,503.37 | $7,503.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,477.46 / $5,477.46 / $7,503.37
| Professional | | $5,477.46 | $5,477.46 | $7,503.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.00 / $9,420.65 / $21,196.46
| Facility | | $319.00 | $9,420.65 | $21,196.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,558.18 / $7,689.33 / $17,164.41
| Professional | | $5,558.18 | $7,689.33 | $17,164.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,663.74 / $6,017.73 / $7,848.77
| Professional | | $5,663.74 | $6,017.73 | $7,848.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.00 / $7,503.37 / $9,420.65
| Facility | | $597.00 | $7,503.37 | $9,420.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,477.46 / $5,612.55 / $14,036.77
| Professional | | $5,477.46 | $5,612.55 | $14,036.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,133.24 / $6,046.21 / $8,616.41
| Professional | | $3,133.24 | $6,046.21 | $8,616.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,663.74 / $5,663.74 / $5,885.68
| Facility | | $5,663.74 | $5,663.74 | $5,885.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,663.74 / $5,663.74 / $6,017.73
| Professional | | $5,663.74 | $5,663.74 | $6,017.73 |