- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $709.76 / $1,270.47 / $3,333.22
| Facility | | $709.76 | $1,270.47 | $3,333.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $580.60 / $697.38 / $1,718.96
| Professional | | $580.60 | $697.38 | $1,718.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.60 / $672.68 / $1,532.00
| Professional | | $514.60 | $672.68 | $1,532.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $903.17 / $903.17 / $903.17
| Facility | | $903.17 | $903.17 | $903.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $903.17 / $903.17 / $903.17
| Professional | | $903.17 | $903.17 | $903.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $730.90 / $5,475.61 / $6,084.01
| Facility | | $730.90 | $5,475.61 | $6,084.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $574.80 / $930.33 / $1,918.16
| Professional | | $574.80 | $930.33 | $1,918.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $332.00 / $678.00 / $1,630.53
| Facility | | $332.00 | $678.00 | $1,630.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $610.48 / $745.80 / $1,343.06
| Professional | | $610.48 | $745.80 | $1,343.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.64 / $165.64 / $165.64
| Facility | | $165.64 | $165.64 | $165.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.64 / $610.48 / $1,203.15
| Professional | | $165.64 | $610.48 | $1,203.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $650.88 / $759.40 / $1,228.63
| Professional | | $650.88 | $759.40 | $1,228.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $254.50 / $730.90 / $6,084.01
| Facility | | $254.50 | $730.90 | $6,084.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $658.13 / $932.79 / $2,068.64
| Professional | | $658.13 | $932.79 | $2,068.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.41 / $724.68 / $1,778.68
| Professional | | $530.41 | $724.68 | $1,778.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $686.59 / $686.59 / $1,876.70
| Facility | | $686.59 | $686.59 | $1,876.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $550.90 / $840.32 / $1,643.74
| Professional | | $550.90 | $840.32 | $1,643.74 |