- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $575.44 / $1,621.81
| Facility | | $158.49 | $575.44 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $229.09 / $645.65
| Professional | | $91.20 | $229.09 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $302.00 / $812.83
| Facility | | $234.42 | $302.00 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $257.04 / $977.24
| Professional | | $107.15 | $257.04 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $630.96 / $912.01
| Facility | | $501.19 | $630.96 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $239.88 / $239.88
| Professional | | $104.71 | $239.88 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $436.52 / $1,000.00
| Facility | | $199.53 | $436.52 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $309.03 / $676.08
| Professional | | $154.88 | $309.03 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58.88 / $3,630.78 / $9,772.37
| Facility | | $58.88 | $3,630.78 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $436.52
| Professional | | $371.54 | $371.54 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $257.04 / $426.58
| Professional | | $257.04 | $257.04 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $107.15 / $302.00
| Facility | | $107.15 | $107.15 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $302.00 / $812.83
| Facility | | $234.42 | $302.00 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $257.04 / $1,023.29
| Professional | | $107.15 | $257.04 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $257.04 / $416.87
| Facility | | $213.80 | $257.04 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $194.98 / $489.78
| Professional | | $67.61 | $194.98 | $489.78 |