- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.10 / $1,328.66 / $3,723.55
| Facility | | $508.10 | $1,328.66 | $3,723.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $424.68 / $530.85 / $910.03
| Professional | | $424.68 | $530.85 | $910.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $765.94 / $2,275.08 / $3,973.81
| Facility | | $765.94 | $2,275.08 | $3,973.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $417.10 / $758.36
| Professional | | $5.00 | $417.10 | $758.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $758.36 / $758.36
| Facility | | $80.00 | $758.36 | $758.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $276.42 / $1,370.35 / $3,229.48
| Facility | | $276.42 | $1,370.35 | $3,229.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.31 / $720.48 / $1,193.72
| Professional | | $384.31 | $720.48 | $1,193.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,213.38 / $3,602.21 / $3,602.21
| Facility | | $1,213.38 | $3,602.21 | $3,602.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,791.80 / $3,791.80 / $5,687.70
| Professional | | $3,791.80 | $3,791.80 | $5,687.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $477.77 / $758.36 / $1,137.54
| Facility | | $477.77 | $758.36 | $1,137.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $720.44 / $758.36 / $947.95
| Professional | | $720.44 | $758.36 | $947.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $492.93 / $910.03 / $1,706.31
| Professional | | $492.93 | $910.03 | $1,706.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $445.91 / $834.20 / $2,475.79
| Facility | | $445.91 | $834.20 | $2,475.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $386.70 / $872.11 / $1,327.13
| Professional | | $386.70 | $872.11 | $1,327.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.51 / $318.51 / $467.15
| Professional | | $318.51 | $318.51 | $467.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.76 / $758.36 / $1,023.79
| Professional | | $295.76 | $758.36 | $1,023.79 |