- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.50 / $5,023.47 / $9,004.35
| Facility | | $715.50 | $5,023.47 | $9,004.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.00 / $477.00 / $2,685.51
| Professional | | $477.00 | $477.00 | $2,685.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,296.00 / $1,296.00 / $3,706.56
| Professional | | $1,296.00 | $1,296.00 | $3,706.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,159.42 / $3,159.42 / $3,159.42
| Facility | | $3,159.42 | $3,159.42 | $3,159.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,306.38 / $3,159.42 / $3,159.42
| Professional | | $2,306.38 | $3,159.42 | $3,159.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,791.30 / $6,674.27 / $8,198.95
| Facility | | $3,791.30 | $6,674.27 | $8,198.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,848.09 / $15,228.40 / $15,228.40
| Professional | | $3,848.09 | $15,228.40 | $15,228.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $3,791.30 / $7,108.70
| Facility | | $294.00 | $3,791.30 | $7,108.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,317.39 / $4,170.43 / $6,855.94
| Professional | | $3,317.39 | $4,170.43 | $6,855.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,685.51 / $3,159.42 / $5,728.96
| Professional | | $2,685.51 | $3,159.42 | $5,728.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,895.60 / $7,708.98 / $8,198.95
| Facility | | $2,895.60 | $7,708.98 | $8,198.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,053.62 / $3,443.77 / $7,266.67
| Professional | | $2,053.62 | $3,443.77 | $7,266.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.96 / $1,895.65 / $4,788.35
| Professional | | $1,326.96 | $1,895.65 | $4,788.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,159.42 / $3,633.26 / $3,633.26
| Facility | | $3,159.42 | $3,633.26 | $3,633.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,685.51 / $3,159.42 / $3,797.36
| Professional | | $2,685.51 | $3,159.42 | $3,797.36 |