- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $2,818.38 / $5,128.61
| Facility | | $724.44 | $2,818.38 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $1,096.48 / $3,311.31
| Professional | | $338.84 | $1,096.48 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $8,317.64 / $28,840.32
| Facility | | $776.25 | $8,317.64 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $912.01 / $3,388.44
| Professional | | $346.74 | $912.01 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $870.96
| Facility | | $371.54 | $371.54 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $1,380.38 / $2,511.89
| Professional | | $549.54 | $1,380.38 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $1,380.38 / $3,235.94
| Professional | | $512.86 | $1,380.38 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $660.69 / $7,079.46
| Facility | | $309.03 | $660.69 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,905.46 / $2,630.27
| Professional | | $1,513.56 | $1,905.46 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $6,918.31 / $15,488.17
| Facility | | $2,570.40 | $6,918.31 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $1,288.25 / $3,311.31
| Professional | | $371.54 | $1,288.25 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,454.71 / $2,454.71
| Professional | | $2,454.71 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $8,709.64 / $28,840.32
| Facility | | $776.25 | $8,709.64 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $912.01 / $3,388.44
| Professional | | $346.74 | $912.01 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $7,244.36 / $15,488.17
| Facility | | $2,570.40 | $7,244.36 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $1,258.93 / $3,388.44
| Professional | | $407.38 | $1,258.93 | $3,388.44 |