- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $2,884.03 / $5,128.61
| Facility | | $426.58 | $2,884.03 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $478.63 / $1,348.96
| Professional | | $281.84 | $478.63 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $3,162.28 / $28,840.32
| Facility | | $741.31 | $3,162.28 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $602.56 / $1,479.11
| Professional | | $346.74 | $602.56 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $831.76
| Facility | | $371.54 | $371.54 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $660.69 / $1,318.26
| Professional | | $371.54 | $660.69 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $660.69 / $1,202.26
| Professional | | $354.81 | $660.69 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $660.69 / $7,079.46
| Facility | | $302.00 | $660.69 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $741.31 / $977.24
| Professional | | $602.56 | $741.31 | $977.24 |
- 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
- $363.08 / $660.69 / $1,348.96
| Professional | | $363.08 | $660.69 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,090.30 / $3,311.31
| Facility | | $3,090.30 | $3,090.30 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $3,162.28 / $28,840.32
| Facility | | $741.31 | $3,162.28 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $602.56 / $1,479.11
| Professional | | $346.74 | $602.56 | $1,479.11 |
- 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
- $363.08 / $630.96 / $1,318.26
| Professional | | $363.08 | $630.96 | $1,318.26 |