- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $5,128.61 / $5,888.44
| Facility | | $5,128.61 | $5,128.61 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,128.61 / $5,623.41 / $6,456.54
| Professional | | $5,128.61 | $5,623.41 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $4,466.84 / $10,715.19
| Facility | | $933.25 | $4,466.84 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $6,165.95 / $8,317.64
| Professional | | $1,862.09 | $6,165.95 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $5,128.61 / $5,128.61
| Facility | | $4,897.79 | $5,128.61 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,128.61 / $5,128.61 / $5,128.61
| Professional | | $5,128.61 | $5,128.61 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $5,128.61 / $6,456.54
| Facility | | $5,128.61 | $5,128.61 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $5,128.61 / $6,456.54
| Professional | | $562.34 | $5,128.61 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $7,244.36 / $12,022.64
| Facility | | $5,011.87 | $7,244.36 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,165.95 / $6,165.95 / $6,456.54
| Professional | | $6,165.95 | $6,165.95 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $5,128.61 / $5,128.61
| Professional | | $1,584.89 | $5,128.61 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,128.61 / $5,128.61 / $5,128.61
| Professional | | $5,128.61 | $5,128.61 | $5,128.61 |