- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $1,659.59 / $1,659.59
| Facility | | $346.74 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $1,096.48 / $2,238.72
| Professional | | $331.13 | $1,096.48 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $7,413.10 / $22,387.21
| Facility | | $4,168.69 | $7,413.10 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $1,698.24 / $4,265.80
| Professional | | $562.34 | $1,698.24 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $5,370.32 / $12,882.50
| Facility | | $3,715.35 | $5,370.32 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $2,344.23 / $5,888.44
| Professional | | $691.83 | $2,344.23 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $5,128.61 / $10,232.93
| Facility | | $4,168.69 | $5,128.61 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $2,344.23 / $5,248.07
| Professional | | $691.83 | $2,344.23 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $2,398.83 / $9,332.54
| Facility | | $549.54 | $2,398.83 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $3,019.95 / $6,309.57
| Professional | | $1,621.81 | $3,019.95 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $6,025.60 / $10,715.19
| Facility | | $3,019.95 | $6,025.60 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $1,513.56 / $5,011.87
| Professional | | $457.09 | $1,513.56 | $5,011.87 |