- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,454.71 / $4,168.69
| Facility | | $831.76 | $2,454.71 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $489.78 / $660.69
| Professional | | $389.05 | $489.78 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,019.95 / $3,019.95
| Facility | | $1,513.56 | $3,019.95 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $288.40 / $537.03
| Professional | | $239.88 | $288.40 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $69.18 / $1,412.54 / $5,754.40
| Facility | | $69.18 | $1,412.54 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $457.09 / $1,000.00
| Professional | | $354.81 | $457.09 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $794.33 / $1,995.26
| Facility | | $398.11 | $794.33 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $660.69 / $891.25
| Professional | | $602.56 | $660.69 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $660.69 / $1,047.13
| Professional | | $537.03 | $660.69 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $2,818.38 / $2,818.38
| Facility | | $2,818.38 | $2,818.38 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,019.95 / $4,466.84 / $4,466.84
| Professional | | $3,019.95 | $4,466.84 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $724.44 / $1,584.89
| Facility | | $457.09 | $724.44 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $660.69 / $660.69
| Professional | | $602.56 | $660.69 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $676.08 / $8,912.51
| Professional | | $478.63 | $676.08 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $602.56 / $602.56
| Facility | | $251.19 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $251.19 / $1,148.15
| Professional | | $251.19 | $251.19 | $1,148.15 |