- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $3,090.30 / $5,128.61
| Facility | | $1,071.52 | $3,090.30 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $616.60 / $870.96
| Professional | | $489.78 | $616.60 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $1,905.46 / $3,801.89
| Facility | | $977.24 | $1,905.46 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $457.09 / $1,513.56
| Professional | | $302.00 | $457.09 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.66 / $1,949.84 / $7,413.10
| Facility | | $61.66 | $1,949.84 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $588.84 / $1,513.56
| Professional | | $446.68 | $588.84 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $977.24 / $2,454.71
| Facility | | $512.86 | $977.24 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $831.76 / $1,023.29
| Professional | | $758.58 | $831.76 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $831.76 / $1,318.26
| Professional | | $691.83 | $831.76 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $3,630.78 / $3,630.78
| Facility | | $3,630.78 | $3,630.78 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,801.89 / $5,754.40 / $5,754.40
| Professional | | $3,801.89 | $5,754.40 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $912.01 / $1,905.46
| Facility | | $588.84 | $912.01 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $831.76 / $1,096.48
| Professional | | $758.58 | $831.76 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $758.58 / $758.58
| Professional | | $758.58 | $758.58 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $758.58 / $758.58
| Facility | | $316.23 | $758.58 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $316.23 / $1,445.44
| Professional | | $316.23 | $316.23 | $1,445.44 |