- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $2,187.76 / $3,801.89
| Facility | | $489.78 | $2,187.76 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $602.56 / $2,187.76
| Professional | | $446.68 | $602.56 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,162.28 / $5,248.07
| Facility | | $56.23 | $3,162.28 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $891.25 / $1,862.09
| Professional | | $501.19 | $891.25 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $630.96 / $1,445.44
| Facility | | $630.96 | $630.96 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,174.90 / $1,737.80
| Professional | | $707.95 | $1,174.90 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $870.96 / $1,778.28
| Professional | | $602.56 | $870.96 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $1,000.00 / $7,079.46
| Facility | | $380.19 | $1,000.00 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $870.96 / $1,230.27
| Professional | | $660.69 | $870.96 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,630.78 / $8,511.38
| Facility | | $1,698.24 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $891.25 / $1,621.81
| Professional | | $549.54 | $891.25 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $1,949.84 / $1,949.84
| Facility | | $1,949.84 | $1,949.84 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,023.29 / $1,023.29
| Professional | | $1,023.29 | $1,023.29 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,162.28 / $5,248.07
| Facility | | $56.23 | $3,162.28 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $870.96 / $1,905.46
| Professional | | $501.19 | $870.96 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,630.78 / $8,511.38
| Facility | | $1,584.89 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $912.01 / $1,621.81
| Professional | | $562.34 | $912.01 | $1,621.81 |