- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $2,089.30 / $3,715.35
| Facility | | $213.80 | $2,089.30 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $275.42 / $741.31
| Professional | | $190.55 | $275.42 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,884.03 / $19,498.45
| Facility | | $537.03 | $2,884.03 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $363.08 / $831.76
| Professional | | $218.78 | $363.08 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $269.15 / $616.60
| Facility | | $269.15 | $269.15 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $501.19 / $776.25
| Professional | | $309.03 | $501.19 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $371.54 / $794.33
| Professional | | $239.88 | $371.54 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $436.52 / $7,079.46
| Facility | | $208.93 | $436.52 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $389.05 / $562.34
| Professional | | $302.00 | $389.05 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,511.89 / $7,079.46
| Facility | | $1,096.48 | $2,511.89 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $389.05 / $758.58
| Professional | | $239.88 | $389.05 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $575.44
| Facility | | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $223.87 / $223.87
| Professional | | $223.87 | $223.87 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $2,884.03 / $19,498.45
| Facility | | $549.54 | $2,884.03 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $363.08 / $851.14
| Professional | | $218.78 | $363.08 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $2,511.89 / $6,165.95
| Facility | | $1,047.13 | $2,511.89 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $371.54 / $724.44
| Professional | | $239.88 | $371.54 | $724.44 |