- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $2,691.53 / $8,317.64
| Facility | | $724.44 | $2,691.53 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $194.98 / $389.05
| Professional | | $162.18 | $194.98 | $389.05 |
- 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
- $199.53 / $208.93 / $346.74
| Professional | | $199.53 | $208.93 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $302.00 / $302.00
| Facility | | $302.00 | $302.00 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $223.87 / $371.54
| Professional | | $173.78 | $223.87 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $323.59 / $407.38
| Professional | | $234.42 | $323.59 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $239.88 / $389.05
| Professional | | $165.96 | $239.88 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $2,398.83 / $8,317.64
| Facility | | $616.60 | $2,398.83 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $251.19 / $562.34
| Professional | | $169.82 | $251.19 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $234.42 / $407.38
| Facility | | $234.42 | $234.42 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $302.00 / $436.52
| Professional | | $218.78 | $302.00 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.51 / $186.21 / $213.80
| Facility | | $29.51 | $186.21 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $186.21 / $213.80
| Professional | | $169.82 | $186.21 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $676.08 / $3,890.45
| Facility | | $223.87 | $676.08 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $213.80 / $346.74
| Professional | | $162.18 | $213.80 | $346.74 |