- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $4,265.80 / $8,511.38
| Facility | | $2,290.87 | $4,265.80 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,698.24 / $3,235.94
| Professional | | $758.58 | $1,698.24 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $6,309.57 / $33,884.42
| Facility | | $1,949.84 | $6,309.57 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,995.26 / $5,370.32
| Professional | | $831.76 | $1,995.26 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $912.01 / $2,137.96
| Facility | | $912.01 | $912.01 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,905.46 / $4,570.88
| Professional | | $870.96 | $1,905.46 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,513.56 / $7,762.47
| Facility | | $707.95 | $1,513.56 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,570.40 / $3,715.35
| Professional | | $2,089.30 | $2,570.40 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,165.95 / $13,182.57
| Facility | | $2,511.89 | $6,165.95 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,949.84 / $4,677.35
| Professional | | $831.76 | $1,949.84 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $7,413.10 / $7,413.10
| Facility | | $7,413.10 | $7,413.10 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $6,309.57 / $33,884.42
| Facility | | $2,454.71 | $6,309.57 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,995.26 / $5,370.32
| Professional | | $831.76 | $1,995.26 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,309.57 / $13,803.84
| Facility | | $2,511.89 | $6,309.57 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,905.46 / $4,677.35
| Professional | | $870.96 | $1,905.46 | $4,677.35 |