- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $2,089.30 / $6,760.83
| Facility | | $309.03 | $2,089.30 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $323.59 / $954.99
| Professional | | $177.83 | $323.59 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $208.93 / $208.93
| Professional | | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,258.93 / $57,543.99
| Facility | | $1,174.90 | $1,258.93 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $316.23 / $478.63
| Professional | | $194.98 | $316.23 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $524.81 / $575.44
| Professional | | $407.38 | $524.81 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $380.19 / $588.84
| Professional | | $229.09 | $380.19 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,023.29 / $2,398.83
| Facility | | $616.60 | $1,023.29 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $331.13 / $380.19
| Professional | | $281.84 | $331.13 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $1,584.89 / $6,165.95
| Facility | | $309.03 | $1,584.89 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $323.59 / $758.58
| Professional | | $181.97 | $323.59 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $263.03 / $263.03
| Professional | | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $269.15 / $407.38
| Facility | | $186.21 | $269.15 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $316.23 / $407.38
| Professional | | $186.21 | $316.23 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $1,071.52 / $3,890.45
| Facility | | $223.87 | $1,071.52 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $281.84 / $478.63
| Professional | | $177.83 | $281.84 | $478.63 |