- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,467.37 / $5,128.61
| Facility | | $3,235.94 | $3,467.37 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $4,073.80 / $5,128.61
| Professional | | $2,951.21 | $4,073.80 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $426.58 / $426.58
| Professional | | $389.05 | $426.58 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $5,754.40 / $6,025.60
| Facility | | $5,754.40 | $5,754.40 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $3,715.35 / $5,128.61
| Facility | | $426.58 | $3,715.35 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $4,570.88 / $5,128.61
| Professional | | $426.58 | $4,570.88 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $30,199.52 / $30,199.52
| Facility | | $8,511.38 | $30,199.52 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $2,951.21 / $5,495.41
| Facility | | $602.56 | $2,951.21 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $4,677.35 / $5,128.61
| Professional | | $2,951.21 | $4,677.35 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $537.03 / $5,248.07
| Professional | | $501.19 | $537.03 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $2,951.21 / $5,495.41
| Facility | | $575.44 | $2,951.21 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $4,677.35 / $4,677.35
| Professional | | $478.63 | $4,677.35 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $2,137.96 / $3,890.45
| Facility | | $295.12 | $2,137.96 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,090.30 / $5,623.41
| Professional | | $2,398.83 | $3,090.30 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,466.84 / $4,466.84 / $4,466.84
| Professional | | $4,466.84 | $4,466.84 | $4,466.84 |