- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,047.13 / $3,311.31
| Facility | | $467.74 | $1,047.13 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $549.54 / $758.58
| Professional | | $436.52 | $549.54 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.29 / $1,737.80 / $3,715.35
| Facility | | $51.29 | $1,737.80 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $79.43 / $79.43
| Facility | | $79.43 | $79.43 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,318.26 / $3,235.94
| Facility | | $467.74 | $1,318.26 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $870.96 / $1,047.13
| Professional | | $380.19 | $870.96 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $3,388.44 / $3,388.44
| Facility | | $3,388.44 | $3,388.44 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $5,370.32 / $5,370.32
| Professional | | $3,630.78 | $5,370.32 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $724.44 / $1,348.96
| Facility | | $549.54 | $724.44 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $575.44 / $891.25
| Professional | | $436.52 | $575.44 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $776.25 / $1,548.82
| Professional | | $724.44 | $776.25 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $741.31 / $2,041.74
| Facility | | $501.19 | $741.31 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $758.58 / $1,258.93
| Professional | | $380.19 | $758.58 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $302.00 / $724.44
| Facility | | $257.04 | $302.00 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $302.00 / $489.78
| Professional | | $302.00 | $302.00 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $724.44 / $724.44
| Professional | | $281.84 | $724.44 | $724.44 |