- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $366.43 / $899.66 / $2,495.39
| Facility | | $366.43 | $899.66 | $2,495.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.98 / $145.12 / $361.61
| Professional | | $112.98 | $145.12 | $361.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $80.00 / $80.00
| Facility | | $80.00 | $80.00 | $80.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $136.72 / $1,131.56 / $2,148.48
| Facility | | $136.72 | $1,131.56 | $2,148.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $587.50 / $587.50 / $703.89
| Professional | | $587.50 | $587.50 | $703.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $771.42 / $2,290.17 / $2,290.17
| Facility | | $771.42 | $2,290.17 | $2,290.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,401.06 / $2,401.06 / $3,616.05
| Professional | | $2,401.06 | $2,401.06 | $3,616.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $289.27 / $482.14 / $705.82
| Facility | | $289.27 | $482.14 | $705.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.14 / $482.14 / $602.67
| Professional | | $482.14 | $482.14 | $602.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.39 / $602.66 / $1,687.49
| Professional | | $313.39 | $602.66 | $1,687.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.31 / $482.14 / $1,736.15
| Facility | | $207.31 | $482.14 | $1,736.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.04 / $554.46 / $675.00
| Professional | | $228.04 | $554.46 | $675.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.07 / $87.07 / $171.53
| Professional | | $87.07 | $87.07 | $171.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.93 / $109.93 / $482.14
| Professional | | $109.93 | $109.93 | $482.14 |