- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $398.11 / $1,258.93
| Facility | | $331.13 | $398.11 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $354.81 / $724.44
| Professional | | $281.84 | $354.81 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $870.96 / $2,290.87
| Facility | | $363.08 | $870.96 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $794.33 / $1,230.27
| Professional | | $537.03 | $794.33 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,288.25 / $3,090.30
| Facility | | $912.01 | $1,288.25 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $380.19 / $380.19 / $380.19
| Facility | 54 | $380.19 | $380.19 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $1,047.13 / $1,548.82
| Professional | | $588.84 | $1,047.13 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,230.27 / $2,398.83
| Facility | | $1,000.00 | $1,230.27 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $912.01 / $1,412.54
| Professional | | $616.60 | $912.01 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $549.54 / $977.24
| Facility | | $323.59 | $549.54 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $707.95 / $2,454.71
| Professional | | $338.84 | $707.95 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,819.70 / $3,467.37
| Facility | | $602.56 | $1,819.70 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $588.84 / $1,174.90
| Professional | | $316.23 | $588.84 | $1,174.90 |