- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $2,187.76 / $3,715.35
| Facility | | $1,071.52 | $2,187.76 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $691.83 / $977.24
| Professional | | $512.86 | $691.83 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $660.69 / $660.69
| Professional | | $660.69 | $660.69 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,148.15 / $2,511.89
| Facility | | $562.34 | $1,148.15 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,073.80 / $4,073.80 / $4,073.80
| Professional | | $4,073.80 | $4,073.80 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,148.15 / $1,819.70
| Professional | | $891.25 | $1,148.15 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $851.14
| Facility | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $977.24 / $1,584.89
| Professional | | $630.96 | $977.24 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,137.96 / $3,715.35
| Facility | | $1,000.00 | $2,137.96 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $691.83 / $2,511.89
| Professional | | $512.86 | $691.83 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,202.26 / $1,202.26
| Professional | | $1,202.26 | $1,202.26 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $851.14 / $933.25
| Facility | | $537.03 | $851.14 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $851.14 / $870.96
| Professional | | $537.03 | $851.14 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $1,023.29
| Facility | | $851.14 | $851.14 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $512.86 / $1,047.13
| Professional | | $354.81 | $512.86 | $1,047.13 |