- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,949.84 / $1,949.84
| Facility | | $851.14 | $1,949.84 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $588.84 / $851.14
| Professional | | $501.19 | $588.84 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.91 / $8.91 / $2,187.76
| Professional | | $8.91 | $8.91 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,290.87 / $3,630.78
| Facility | | $1,949.84 | $2,290.87 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,071.52 / $2,238.72
| Professional | | $812.83 | $1,071.52 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $2,454.71 / $4,168.69
| Facility | | $426.58 | $2,454.71 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $645.65 / $3,388.44
| Facility | | $426.58 | $645.65 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $426.58 / $1,288.25
| Professional | | $354.81 | $426.58 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $85.11 / $1,071.52
| Professional | | $85.11 | $85.11 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,659.59 / $2,344.23
| Professional | | $912.01 | $1,659.59 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,412.54 / $3,388.44
| Facility | | $1,412.54 | $1,412.54 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,513.56 / $1,513.56
| Professional | | $1,513.56 | $1,513.56 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,890.45 / $3,890.45 / $3,890.45
| Professional | | $3,890.45 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $851.14
| Facility | | $575.44 | $575.44 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $426.58 / $1,380.38
| Professional | | $302.00 | $426.58 | $1,380.38 |