- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.50 / $446.68 / $1,445.44
| Facility | | $95.50 | $446.68 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $134.90 / $281.84
| Professional | | $95.50 | $134.90 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $575.44 / $2,818.38
| Facility | | $56.23 | $575.44 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $173.78 / $407.38
| Professional | | $100.00 | $173.78 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $114.82 / $257.04
| Facility | | $114.82 | $114.82 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $194.98 / $346.74
| Professional | | $114.82 | $194.98 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $50.12 / $50.12
| Facility | | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $194.98 / $338.84
| Professional | | $109.65 | $194.98 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $194.98 / $7,079.46
| Facility | | $91.20 | $194.98 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $186.21 / $257.04
| Professional | | $151.36 | $186.21 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,041.74 / $3,467.37
| Facility | | $630.96 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $190.55 / $346.74
| Professional | | $109.65 | $190.55 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $489.78 / $588.84
| Facility | | $446.68 | $489.78 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $117.49 / $213.80
| Professional | | $117.49 | $117.49 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $575.44 / $2,818.38
| Facility | | $56.23 | $575.44 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $173.78 / $407.38
| Professional | | $102.33 | $173.78 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,819.70 / $2,818.38
| Facility | | $501.19 | $1,819.70 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $181.97 / $346.74
| Professional | | $112.20 | $181.97 | $346.74 |