- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $537.03 / $1,698.24
| Facility | | $223.87 | $537.03 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $281.84 / $407.38
| Professional | | $223.87 | $281.84 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $79.43 / $79.43
| Facility | | $79.43 | $79.43 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $676.08 / $1,659.59
| Facility | | $245.47 | $676.08 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $416.87 / $501.19
| Professional | | $181.97 | $416.87 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $1,778.28 / $1,778.28
| Facility | | $1,778.28 | $1,778.28 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,818.38 / $2,818.38
| Professional | | $1,862.09 | $2,818.38 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $380.19 / $691.83
| Facility | | $281.84 | $380.19 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $302.00 / $467.74
| Professional | | $223.87 | $302.00 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $446.68 / $851.14
| Professional | | $371.54 | $446.68 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $398.11 / $1,096.48
| Facility | | $263.03 | $398.11 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $398.11 / $660.69
| Professional | | $181.97 | $398.11 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $371.54
| Facility | | $371.54 | $371.54 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $158.49 / $257.04
| Professional | | $158.49 | $158.49 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $147.91 / $371.54
| Professional | | $147.91 | $147.91 | $371.54 |