- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $5,754.40 / $5,754.40
| Facility | | $3,388.44 | $5,754.40 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $275.42 / $707.95
| Professional | | $223.87 | $275.42 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $3,890.45 / $8,317.64
| Facility | | $1,659.59 | $3,890.45 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $467.74 / $501.19
| Professional | | $407.38 | $467.74 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $363.08 / $501.19
| Professional | | $239.88 | $363.08 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $389.05 / $741.31
| Facility | | $245.47 | $389.05 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $398.11 / $489.78
| Professional | | $251.19 | $398.11 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $7,244.36 / $10,232.93
| Facility | | $5,248.07 | $7,244.36 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $467.74 / $501.19
| Professional | | $363.08 | $467.74 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $229.09 / $5,754.40
| Professional | | $208.93 | $229.09 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $12,302.69 / $12,302.69
| Facility | | $5,495.41 | $12,302.69 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $338.84 / $501.19
| Professional | | $234.42 | $338.84 | $501.19 |