- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,671.62 / $5,904.74 / $7,368.86
| Facility | | $4,671.62 | $5,904.74 | $7,368.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,056.17 / $5,979.44 / $7,368.86
| Professional | | $5,056.17 | $5,979.44 | $7,368.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,637.21 / $10,725.96 / $17,807.66
| Professional | | $8,637.21 | $10,725.96 | $17,807.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,415.48 / $15,415.48 / $15,538.80
| Facility | | $15,415.48 | $15,415.48 | $15,538.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,415.48 / $15,415.48 / $15,415.48
| Professional | | $15,415.48 | $15,415.48 | $15,415.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,551.49 / $7,551.49 / $7,551.49
| Facility | | $7,551.49 | $7,551.49 | $7,551.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,418.77 / $6,418.77 / $7,551.49
| Professional | | $6,418.77 | $6,418.77 | $7,551.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,481.34 / $11,481.34 / $11,481.34
| Professional | | $11,481.34 | $11,481.34 | $11,481.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,900.00 / $19,900.00 / $19,900.00
| Facility | | $19,900.00 | $19,900.00 | $19,900.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.00 / $7,551.49 / $7,551.49
| Facility | | $597.00 | $7,551.49 | $7,551.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,418.77 / $6,418.77 / $7,551.49
| Professional | | $6,418.77 | $6,418.77 | $7,551.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,417.52 / $7,056.17 / $13,952.03
| Professional | | $4,417.52 | $7,056.17 | $13,952.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,718.59 / $10,718.59 / $10,718.59
| Facility | | $10,718.59 | $10,718.59 | $10,718.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,718.59 / $11,481.34 / $11,481.34
| Professional | | $10,718.59 | $11,481.34 | $11,481.34 |