- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $327.83 / $744.65 / $1,334.74
| Facility | | $327.83 | $744.65 | $1,334.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.21 / $281.00 / $398.08
| Professional | | $248.21 | $281.00 | $398.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.20 / $187.20 / $570.96
| Professional | | $187.20 | $187.20 | $570.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $468.33 / $468.33 / $468.33
| Facility | | $468.33 | $468.33 | $468.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.88 / $468.33 / $468.33
| Professional | | $341.88 | $468.33 | $468.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.00 / $989.33 / $1,215.13
| Facility | | $562.00 | $989.33 | $1,215.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $570.42 / $2,257.35 / $2,257.35
| Professional | | $570.42 | $2,257.35 | $2,257.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $608.83 / $1,053.74
| Facility | | $294.00 | $608.83 | $1,053.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $491.75 / $618.20 / $1,016.28
| Professional | | $491.75 | $618.20 | $1,016.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.08 / $468.33 / $849.22
| Professional | | $398.08 | $468.33 | $849.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.00 / $1,142.52 / $1,215.13
| Facility | | $555.00 | $1,142.52 | $1,215.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.41 / $510.48 / $1,077.16
| Professional | | $304.41 | $510.48 | $1,077.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.70 / $281.00 / $735.21
| Professional | | $196.70 | $281.00 | $735.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $468.33 / $538.57 / $538.57
| Facility | | $468.33 | $538.57 | $538.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.08 / $468.33 / $562.89
| Professional | | $398.08 | $468.33 | $562.89 |