- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $2,238.72 / $6,025.60
| Facility | | $316.23 | $2,238.72 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $281.84 / $1,348.96
| Professional | | $131.83 | $281.84 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $120.23 / $138.04
| Professional | | $66.07 | $120.23 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,073.80 / $5,888.44
| Facility | | $3,388.44 | $4,073.80 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $288.40 / $501.19
| Professional | | $134.90 | $288.40 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $251.19 / $478.63
| Professional | | $138.04 | $251.19 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $288.40 / $1,202.26
| Professional | | $117.49 | $288.40 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,047.13 / $1,047.13
| Facility | | $1,047.13 | $1,047.13 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $416.87 / $1,584.89
| Professional | | $177.83 | $416.87 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $281.84 / $281.84
| Professional | | $117.49 | $281.84 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,344.23 / $7,244.36
| Facility | | $1,288.25 | $2,344.23 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $275.42 / $467.74
| Professional | | $138.04 | $275.42 | $467.74 |