- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.66 / $537.66 / $537.66
| Facility | | $537.66 | $537.66 | $537.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.66 / $592.65 / $788.13
| Professional | | $537.66 | $592.65 | $788.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,101.01 / $3,505.48 / $5,871.01
| Facility | | $1,101.01 | $3,505.48 | $5,871.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.19 / $914.11 / $1,201.74
| Professional | | $510.19 | $914.11 | $1,201.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,343.64 / $1,589.05 / $2,046.39
| Facility | | $1,343.64 | $1,589.05 | $2,046.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $886.35 / $1,128.28 / $1,128.28
| Professional | | $886.35 | $1,128.28 | $1,128.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.89 / $741.89 / $741.89
| Facility | | $741.89 | $741.89 | $741.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.58 / $741.89 / $1,461.75
| Professional | | $541.58 | $741.89 | $1,461.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $996.34 / $996.34 / $1,046.16
| Professional | | $996.34 | $996.34 | $1,046.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $898.35 / $898.35 / $898.35
| Professional | | $898.35 | $898.35 | $898.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,559.32 / $5,871.01 / $5,871.01
| Facility | | $2,559.32 | $5,871.01 | $5,871.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $468.24 / $613.91 / $1,201.74
| Professional | | $468.24 | $613.91 | $1,201.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $476.22 / $657.77 / $1,201.74
| Professional | | $476.22 | $657.77 | $1,201.74 |