- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,204.77 / $4,044.46 / $6,220.56
| Facility | | $1,204.77 | $4,044.46 | $6,220.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.00 / $1,204.77 / $9,563.79
| Professional | | $58.00 | $1,204.77 | $9,563.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $6,650.92 / $10,109.20
| Facility | | $5,000.00 | $6,650.92 | $10,109.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,160.15 / $1,160.15 / $1,160.15
| Professional | | $1,160.15 | $1,160.15 | $1,160.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $995.79 / $1,933.58 / $4,350.56
| Facility | | $995.79 | $1,933.58 | $4,350.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,102.98 / $1,708.99 / $2,136.23
| Professional | | $1,102.98 | $1,708.99 | $2,136.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.55 / $877.55 / $2,013.90
| Professional | | $31.55 | $877.55 | $2,013.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $706.35 / $2,348.11 / $2,645.88
| Facility | | $706.35 | $2,348.11 | $2,645.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,070.91 / $3,514.64 / $6,142.84
| Facility | | $1,070.91 | $3,514.64 | $6,142.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $937.04 / $1,219.64 / $6,142.84
| Professional | | $937.04 | $1,219.64 | $6,142.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,039.33 / $2,302.19 / $4,935.35
| Facility | | $1,039.33 | $2,302.19 | $4,935.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,429.58 / $1,708.99 / $2,136.23
| Professional | | $1,429.58 | $1,708.99 | $2,136.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,487.37 / $1,487.37 / $1,636.11
| Facility | | $1,487.37 | $1,487.37 | $1,636.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,308.89 / $1,487.37 / $1,636.11
| Professional | | $1,308.89 | $1,487.37 | $1,636.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $624.70 / $922.17 / $2,721.89
| Professional | | $624.70 | $922.17 | $2,721.89 |