- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,388.44 / $5,623.41
| Facility | | $1,949.84 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $223.87 / $724.44
| Professional | | $181.97 | $223.87 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $3,981.07 / $33,884.42
| Facility | | $501.19 | $3,981.07 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $309.03 / $1,445.44
| Professional | | $186.21 | $309.03 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $1,659.59 / $1,659.59
| Professional | | $416.87 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $912.01 / $2,691.53
| Facility | | $676.08 | $912.01 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $302.00 / $549.54
| Professional | | $190.55 | $302.00 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $575.44 / $7,079.46
| Facility | | $190.55 | $575.44 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $275.42 / $398.11
| Professional | | $194.98 | $275.42 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $3,801.89 / $9,772.37
| Facility | | $524.81 | $3,801.89 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $338.84 / $524.81
| Professional | | $186.21 | $338.84 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $4,073.80 / $4,073.80
| Facility | | $4,073.80 | $4,073.80 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $3,981.07 / $33,884.42
| Facility | | $501.19 | $3,981.07 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $309.03 / $1,445.44
| Professional | | $186.21 | $309.03 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $3,890.45 / $9,549.93
| Facility | | $1,071.52 | $3,890.45 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $288.40 / $575.44
| Professional | | $186.21 | $288.40 | $575.44 |