- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $561.63 / $1,556.52 / $2,485.83
| Facility | | $561.63 | $1,556.52 | $2,485.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.49 / $561.63 / $649.89
| Professional | | $368.49 | $561.63 | $649.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $533.53 / $1,026.04 / $3,500.00
| Facility | | $533.53 | $1,026.04 | $3,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.94 / $584.90 / $2,196.32
| Professional | | $350.94 | $584.90 | $2,196.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,030.86 / $1,584.18 / $2,869.90
| Facility | | $1,030.86 | $1,584.18 | $2,869.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.04 / $754.19 / $754.19
| Professional | | $579.04 | $754.19 | $754.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $408.71 / $565.85 / $1,330.67
| Facility | | $408.71 | $565.85 | $1,330.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.94 / $584.55 / $1,524.63
| Professional | | $350.94 | $584.55 | $1,524.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $802.33 / $802.33 / $802.33
| Facility | | $802.33 | $802.33 | $802.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $843.88 / $843.88 / $992.80
| Professional | | $843.88 | $843.88 | $992.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $584.90 / $584.90 / $1,901.95
| Professional | | $584.90 | $584.90 | $1,901.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,500.00 / $3,500.00 / $3,500.00
| Facility | | $3,500.00 | $3,500.00 | $3,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,026.04 / $3,500.00 / $3,500.00
| Facility | | $1,026.04 | $3,500.00 | $3,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.82 / $481.40 / $2,924.50
| Professional | | $280.82 | $481.40 | $2,924.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $526.41 / $584.90 / $701.88
| Facility | | $526.41 | $584.90 | $701.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.66 / $350.94 / $1,123.58
| Professional | | $245.66 | $350.94 | $1,123.58 |