- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $1,258.93 / $4,073.80
| Facility | | $120.23 | $1,258.93 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $213.80 / $575.44
| Professional | | $91.20 | $213.80 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $758.58 / $2,818.38
| Facility | | $56.23 | $758.58 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $177.83 / $446.68
| Professional | | $97.72 | $177.83 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $128.82 / $288.40
| Facility | | $128.82 | $128.82 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $218.78 / $398.11
| Professional | | $128.82 | $218.78 | $398.11 |
- 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
- $125.89 / $218.78 / $407.38
| Professional | | $125.89 | $218.78 | $407.38 |
- 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
- $123.03 / $199.53 / $407.38
| Professional | | $123.03 | $199.53 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $426.58 / $630.96
| Facility | | $162.18 | $426.58 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $208.93 / $251.19
| Professional | | $128.82 | $208.93 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $758.58 / $2,818.38
| Facility | | $56.23 | $758.58 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $181.97 / $457.09
| Professional | | $95.50 | $181.97 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,819.70 / $2,818.38
| Facility | | $575.44 | $1,819.70 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $190.55 / $371.54
| Professional | | $104.71 | $190.55 | $371.54 |