- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $1,122.02 / $1,905.46
| Facility | | $380.19 | $1,122.02 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $223.87 / $302.00
| Professional | | $177.83 | $223.87 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,380.38 / $1,380.38
| Facility | | $691.83 | $1,380.38 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $257.04 / $446.68
| Professional | | $151.36 | $257.04 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $69.18 / $645.65 / $2,630.27
| Facility | | $69.18 | $645.65 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $213.80 / $549.54
| Professional | | $162.18 | $213.80 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $457.09 / $977.24
| Facility | | $181.97 | $457.09 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $302.00 / $371.54
| Professional | | $218.78 | $302.00 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $302.00 / $478.63
| Professional | | $245.47 | $302.00 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $1,318.26
| Facility | | $1,318.26 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,041.74 / $2,041.74
| Professional | | $1,380.38 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $331.13 / $724.44
| Facility | | $208.93 | $331.13 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $302.00 / $398.11
| Professional | | $275.42 | $302.00 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $275.42 / $3,311.31
| Professional | | $218.78 | $275.42 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $275.42 / $275.42
| Facility | | $114.82 | $275.42 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $114.82 / $524.81
| Professional | | $114.82 | $114.82 | $524.81 |