- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $3,090.30 / $5,128.61
| Facility | | $1,047.13 | $3,090.30 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $616.60 / $758.58
| Professional | | $501.19 | $616.60 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,715.35 / $3,801.89
| Facility | | $1,905.46 | $3,715.35 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $12.02 / $457.09
| Professional | | $10.72 | $12.02 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $69.18 / $1,737.80 / $7,244.36
| Facility | | $69.18 | $1,737.80 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $562.34 / $1,380.38
| Professional | | $436.52 | $562.34 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $977.24 / $2,511.89
| Facility | | $501.19 | $977.24 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $912.01 / $1,148.15
| Professional | | $870.96 | $912.01 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $758.58 / $1,202.26
| Professional | | $100.00 | $758.58 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $758.58 / $1,318.26
| Professional | | $602.56 | $758.58 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $3,548.13
| Facility | | $3,548.13 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.95 / $19.95 / $19.95
| Professional | | $19.95 | $19.95 | $19.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $851.14 / $1,905.46
| Facility | | $446.68 | $851.14 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $758.58 / $831.76
| Professional | | $575.44 | $758.58 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $416.87 / $758.58
| Facility | | $316.23 | $416.87 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $338.84 / $1,348.96
| Professional | | $316.23 | $338.84 | $1,348.96 |