- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,445.44 / $1,445.44
| Facility | | $630.96 | $1,445.44 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $426.58 / $562.34
| Professional | | $371.54 | $426.58 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $69.18 / $1,548.82
| Professional | | $58.88 | $69.18 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,698.24 / $2,691.53
| Facility | | $1,445.44 | $1,698.24 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $794.33 / $1,659.59
| Professional | | $602.56 | $794.33 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $1,819.70 / $3,090.30
| Facility | | $316.23 | $1,819.70 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $489.78 / $2,511.89
| Facility | | $316.23 | $489.78 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $316.23 / $954.99
| Professional | | $263.03 | $316.23 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $54.95 / $794.33
| Professional | | $50.12 | $54.95 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,202.26 / $1,737.80
| Professional | | $676.08 | $1,202.26 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,047.13 / $2,511.89
| Facility | | $1,047.13 | $1,047.13 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,122.02 / $1,122.02
| Professional | | $1,122.02 | $1,122.02 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,884.03 / $3,981.07
| Professional | | $1,513.56 | $2,884.03 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $630.96
| Facility | | $416.87 | $416.87 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $316.23 / $1,023.29
| Professional | | $218.78 | $316.23 | $1,023.29 |