- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.38 / $1,529.90 / $6,025.19
| Facility | | $110.38 | $1,529.90 | $6,025.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.47 / $109.55 / $148.96
| Professional | | $108.47 | $109.55 | $148.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.46 / $117.68 / $8,459.92
| Facility | | $100.46 | $117.68 | $8,459.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.56 / $112.56 / $112.56
| Professional | | $112.56 | $112.56 | $112.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $108.47 / $108.47
| Facility | | $102.33 | $108.47 | $108.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.47 / $108.47 / $112.56
| Professional | | $108.47 | $108.47 | $112.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.56 / $117.68 / $146.94
| Professional | | $112.56 | $117.68 | $146.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.01 / $363.01 / $623.40
| Facility | | $363.01 | $363.01 | $623.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.62 / $381.62 / $381.62
| Professional | | $381.62 | $381.62 | $381.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.38 / $300.52 / $3,041.54
| Facility | | $110.38 | $300.52 | $3,041.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.47 / $110.38 / $332.21
| Professional | | $108.47 | $110.38 | $332.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.40 / $208.02 / $451.20
| Professional | | $27.40 | $208.02 | $451.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $108.47 / $108.47
| Facility | | $102.33 | $108.47 | $108.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.47 / $108.47 / $138.13
| Professional | | $108.47 | $108.47 | $138.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.24 / $102.24 / $118.63
| Facility | | $102.24 | $102.24 | $118.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.24 / $102.24 / $118.63
| Professional | | $102.24 | $102.24 | $118.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.47 / $114.98 / $162.71
| Professional | | $108.47 | $114.98 | $162.71 |