- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $2,238.72 / $4,677.35
| Facility | | $870.96 | $2,238.72 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $870.96 / $2,344.23
| Professional | | $338.84 | $870.96 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $5,128.61 / $19,498.45
| Facility | | $812.83 | $5,128.61 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $912.01 / $2,691.53
| Professional | | $363.08 | $912.01 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $389.05 / $912.01
| Facility | | $389.05 | $389.05 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $954.99 / $2,511.89
| Professional | | $436.52 | $954.99 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $645.65 / $7,079.46
| Facility | | $302.00 | $645.65 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $1,023.29 / $1,548.82
| Professional | | $549.54 | $1,023.29 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,265.80 / $9,772.37
| Facility | | $1,995.26 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $891.25 / $2,238.72
| Professional | | $371.54 | $891.25 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,737.80 / $2,818.38
| Facility | | $912.01 | $1,737.80 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $812.83
| Professional | | $812.83 | $812.83 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $5,370.32 / $19,498.45
| Facility | | $812.83 | $5,370.32 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $912.01 / $2,630.27
| Professional | | $363.08 | $912.01 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,265.80 / $9,772.37
| Facility | | $1,862.09 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $954.99 / $2,290.87
| Professional | | $398.11 | $954.99 | $2,290.87 |