- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,076.16 / $4,431.24 / $5,295.06
| Facility | | $1,076.16 | $4,431.24 | $5,295.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $759.64 / $1,025.52 / $1,076.16
| Professional | | $759.64 | $1,025.52 | $1,076.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $987.53 / $987.53 / $987.53
| Professional | | $987.53 | $987.53 | $987.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $847.64 / $1,685.98 / $4,201.89
| Facility | | $847.64 | $1,685.98 | $4,201.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,102.46 / $6,102.46 / $6,102.46
| Professional | | $6,102.46 | $6,102.46 | $6,102.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,329.37 / $1,709.19 / $3,127.19
| Professional | | $1,329.37 | $1,709.19 | $3,127.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,409.77 / $4,368.72 / $5,295.06
| Facility | | $1,409.77 | $4,368.72 | $5,295.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $830.92 / $1,076.16 / $5,228.87
| Professional | | $830.92 | $1,076.16 | $5,228.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,873.78 / $1,899.11 / $2,532.14
| Professional | | $1,873.78 | $1,899.11 | $2,532.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $847.64 / $1,685.98 / $4,201.89
| Facility | | $847.64 | $1,685.98 | $4,201.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,102.46 / $6,102.46 / $6,102.46
| Professional | | $6,102.46 | $6,102.46 | $6,102.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,266.07 / $1,266.07 / $1,392.68
| Facility | | $1,266.07 | $1,266.07 | $1,392.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,266.07 / $1,266.07 / $1,392.68
| Professional | | $1,266.07 | $1,266.07 | $1,392.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.75 / $759.64 / $1,690.46
| Professional | | $531.75 | $759.64 | $1,690.46 |