- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,212.44 / $3,212.44 / $3,212.44
| Facility | | $3,212.44 | $3,212.44 | $3,212.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,212.44 / $3,212.44 / $5,173.14
| Professional | | $3,212.44 | $3,212.44 | $5,173.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,578.20 / $19,635.93 / $33,517.87
| Facility | | $6,578.20 | $19,635.93 | $33,517.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,299.81 / $5,301.52 / $7,180.03
| Professional | | $3,299.81 | $5,301.52 | $7,180.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,761.35 / $9,488.11 / $12,172.17
| Facility | | $7,761.35 | $9,488.11 | $12,172.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,021.39 / $6,523.59 / $6,523.59
| Professional | | $5,021.39 | $6,523.59 | $6,523.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,423.18 / $4,423.18 / $4,423.18
| Facility | | $4,423.18 | $4,423.18 | $4,423.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,228.92 / $4,423.18 / $7,926.75
| Professional | | $3,228.92 | $4,423.18 | $7,926.75 |
- 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
- $5,952.87 / $5,952.87 / $6,250.51
| Professional | | $5,952.87 | $5,952.87 | $6,250.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,081.57 / $5,081.57 / $5,081.57
| Professional | | $5,081.57 | $5,081.57 | $5,081.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,880.33 / $33,517.87 / $33,517.87
| Facility | | $13,880.33 | $33,517.87 | $33,517.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,872.01 / $4,099.10 / $7,180.03
| Professional | | $2,872.01 | $4,099.10 | $7,180.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,872.01 / $4,099.10 / $7,375.88
| Professional | | $2,872.01 | $4,099.10 | $7,375.88 |