- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $2,290.87 / $4,073.80
| Facility | | $467.74 | $2,290.87 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $218.78 / $660.69
| Professional | | $173.78 | $218.78 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,818.38 / $3,801.89
| Facility | | $1,380.38 | $2,818.38 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $269.15 / $416.87
| Professional | | $181.97 | $269.15 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $933.25 / $1,949.84
| Facility | | $316.23 | $933.25 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $269.15 / $758.58
| Professional | | $186.21 | $269.15 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $56.23 / $4,897.79
| Facility | | $54.95 | $56.23 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,715.35 / $4,466.84 / $4,466.84
| Professional | | $3,715.35 | $4,466.84 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,187.76 / $3,981.07
| Facility | | $1,000.00 | $2,187.76 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $218.78 / $389.05
| Professional | | $162.18 | $218.78 | $389.05 |