- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $8,128.31 / $11,481.54
| Facility | | $933.25 | $8,128.31 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $2,187.76 / $2,691.53
| Professional | | $457.09 | $2,187.76 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $2,137.96
| Professional | | $2,137.96 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $4,365.16 / $9,332.54
| Facility | | $2,691.53 | $4,365.16 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,182.57 / $13,182.57 / $13,182.57
| Professional | | $13,182.57 | $13,182.57 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,715.35 / $6,025.60
| Professional | | $2,884.03 | $3,715.35 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $2,754.23 / $2,754.23
| Facility | | $2,754.23 | $2,754.23 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $4,570.88 / $6,918.31
| Professional | | $2,951.21 | $4,570.88 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $7,413.10 / $11,481.54
| Facility | | $933.25 | $7,413.10 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $2,238.72 / $9,772.37
| Professional | | $457.09 | $2,238.72 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,890.45 / $3,890.45 / $3,890.45
| Professional | | $3,890.45 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,019.95 / $3,019.95
| Facility | | $2,754.23 | $3,019.95 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $2,754.23 / $3,019.95
| Professional | | $2,754.23 | $2,754.23 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $2,754.23 / $3,311.31
| Facility | | $2,754.23 | $2,754.23 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,659.59 / $3,467.37
| Professional | | $1,148.15 | $1,659.59 | $3,467.37 |