- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,884.03 / $5,128.61
| Facility | | $1,513.56 | $2,884.03 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $380.19 / $891.25
| Professional | | $309.03 | $380.19 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $4,570.88 / $28,840.32
| Facility | | $812.83 | $4,570.88 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $512.86 / $2,884.03
| Professional | | $302.00 | $512.86 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $524.81 / $977.24
| Professional | | $346.74 | $524.81 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $758.58 / $7,079.46
| Facility | | $346.74 | $758.58 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $478.63 / $660.69
| Professional | | $389.05 | $478.63 | $660.69 |
- 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
- $346.74 / $645.65 / $1,023.29
| Professional | | $346.74 | $645.65 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $4,570.88 / $28,840.32
| Facility | | $831.76 | $4,570.88 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $512.86 / $2,884.03
| Professional | | $302.00 | $512.86 | $2,884.03 |
- 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
- $331.13 / $512.86 / $1,071.52
| Professional | | $331.13 | $512.86 | $1,071.52 |