- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $2,818.38 / $5,011.87
| Facility | | $371.54 | $2,818.38 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $371.54 / $977.24
| Professional | | $245.47 | $371.54 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $5,011.87 / $28,840.32
| Facility | | $630.96 | $5,011.87 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $446.68 / $2,630.27
| Professional | | $269.15 | $446.68 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $302.00 / $691.83
| Facility | | $302.00 | $302.00 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $758.58 / $1,659.59
| Professional | | $524.81 | $758.58 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $645.65 / $3,090.30
| Facility | | $588.84 | $645.65 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $436.52 / $912.01
| Professional | | $257.04 | $436.52 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $512.86 / $7,079.46
| Facility | | $239.88 | $512.86 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $562.34 / $776.25
| Professional | | $389.05 | $562.34 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $5,011.87 / $13,182.57
| Facility | | $776.25 | $5,011.87 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $478.63 / $933.25
| Professional | | $281.84 | $478.63 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $5,011.87 / $28,840.32
| Facility | | $630.96 | $5,011.87 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $446.68 / $2,630.27
| Professional | | $269.15 | $446.68 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $5,011.87 / $12,882.50
| Facility | | $1,584.89 | $5,011.87 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $446.68 / $912.01
| Professional | | $263.03 | $446.68 | $912.01 |