- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $352.80 / $1,380.61 / $1,535.99
| Facility | | $352.80 | $1,380.61 | $1,535.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.80 / $352.80 / $776.16
| Professional | | $352.80 | $352.80 | $776.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $372.38 / $876.96 / $2,394.00
| Facility | | $372.38 | $876.96 | $2,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.39 / $504.00 / $1,892.54
| Professional | | $302.39 | $504.00 | $1,892.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.60 / $1,077.90 / $2,002.05
| Facility | | $15.60 | $1,077.90 | $2,002.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $463.68 / $463.68 / $463.68
| Professional | | $463.68 | $463.68 | $463.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $327.60 / $360.36 / $982.60
| Facility | | $327.60 | $360.36 | $982.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.00 / $453.23 / $2,248.28
| Professional | | $252.00 | $453.23 | $2,248.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $727.19 / $727.19 / $855.52
| Professional | | $727.19 | $727.19 | $855.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.00 / $504.00 / $1,638.88
| Professional | | $504.00 | $504.00 | $1,638.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $475.68 / $475.68 / $475.68
| Facility | | $475.68 | $475.68 | $475.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $876.96 / $2,394.00 / $2,394.00
| Facility | | $876.96 | $2,394.00 | $2,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.80 / $302.39 / $2,520.00
| Professional | | $226.80 | $302.39 | $2,520.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.68 / $302.39 / $1,041.67
| Professional | | $211.68 | $302.39 | $1,041.67 |