- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $3,162.28 / $7,943.28
| Facility | | $794.33 | $3,162.28 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $660.69 / $1,096.48
| Professional | | $562.34 | $660.69 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $4,365.16 / $8,709.64
| Facility | | $2,454.71 | $4,365.16 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $588.84 / $588.84
| Facility | | $79.43 | $588.84 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $851.14 / $1,318.26
| Professional | | $616.60 | $851.14 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $28,840.32 / $28,840.32
| Facility | | $8,912.51 | $28,840.32 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $5,495.41 / $5,495.41
| Professional | | $4,677.35 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $870.96 / $3,715.35
| Facility | | $616.60 | $870.96 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $794.33 / $1,071.52
| Professional | | $562.34 | $794.33 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $588.84
| Professional | | $32.36 | $33.11 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $741.31 / $1,202.26
| Professional | | $741.31 | $741.31 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $812.83 / $1,380.38
| Facility | | $602.56 | $812.83 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $831.76 / $1,318.26
| Professional | | $588.84 | $831.76 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $5,248.07 / $10,964.78
| Facility | | $1,698.24 | $5,248.07 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $660.69 / $1,023.29
| Professional | | $501.19 | $660.69 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $616.60 / $616.60
| Professional | | $575.44 | $616.60 | $616.60 |