- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.86 / $3,780.50 / $8,373.50
| Facility | | $199.86 | $3,780.50 | $8,373.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.72 / $189.43 / $234.16
| Professional | | $153.72 | $189.43 | $234.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.00 / $3,823.78 / $8,642.77
| Facility | | $97.00 | $3,823.78 | $8,642.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,921.98 / $2,050.11 / $2,216.67
| Facility | | $1,921.98 | $2,050.11 | $2,216.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,486.55 / $6,262.50 / $11,522.50
| Facility | | $3,486.55 | $6,262.50 | $11,522.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,394.44 / $7,555.36 / $13,906.25
| Facility | | $3,394.44 | $7,555.36 | $13,906.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $287.56 / $343.07 / $442.60
| Facility | | $287.56 | $343.07 | $442.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.93 / $507.57 / $507.57
| Professional | | $416.93 | $507.57 | $507.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,020.00 / $1,200.00 / $1,200.00
| Professional | | $1,020.00 | $1,200.00 | $1,200.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.34 / $360.77 / $631.90
| Professional | | $272.34 | $360.77 | $631.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.61 / $294.55 / $329.31
| Professional | | $141.61 | $294.55 | $329.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.50 / $45.00 / $100.00
| Professional | | $31.50 | $45.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $205.15 / $209.32 / $602.85
| Facility | | $205.15 | $209.32 | $602.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $396.55 / $435.81 / $616.75
| Professional | | $396.55 | $435.81 | $616.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,200.00 / $5,111.00 / $9,202.00
| Facility | | $2,200.00 | $5,111.00 | $9,202.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.91 / $339.70 / $551.42
| Professional | | $249.91 | $339.70 | $551.42 |