- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.72 / $924.82 / $2,571.56
| Facility | | $316.72 | $924.82 | $2,571.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.61 / $348.39 / $448.69
| Professional | | $295.61 | $348.39 | $448.69 |
- 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
- $343.12 / $1,200.92 / $2,352.32
| Facility | | $343.12 | $1,200.92 | $2,352.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $643.10 / $643.10 / $770.51
| Professional | | $643.10 | $643.10 | $770.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $844.59 / $2,507.38 / $2,507.38
| Facility | | $844.59 | $2,507.38 | $2,507.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,628.79 / $2,628.79 / $3,959.03
| Professional | | $2,628.79 | $2,628.79 | $3,959.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.72 / $527.87 / $778.86
| Facility | | $316.72 | $527.87 | $778.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $527.87 / $527.87 / $659.84
| Professional | | $527.87 | $527.87 | $659.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $475.08 / $659.84 / $1,187.71
| Professional | | $475.08 | $659.84 | $1,187.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $343.12 / $528.40 / $1,594.77
| Facility | | $343.12 | $528.40 | $1,594.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $475.08 / $633.44 / $923.77
| Professional | | $475.08 | $633.44 | $923.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.71 / $221.71 / $325.17
| Professional | | $221.71 | $221.71 | $325.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.15 / $211.15 / $527.87
| Professional | | $211.15 | $211.15 | $527.87 |