- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $2,570.40 / $4,897.79
| Facility | | $190.55 | $2,570.40 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $213.80 / $707.95
| Professional | | $120.23 | $213.80 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $1,659.59 / $28,840.32
| Facility | | $354.81 | $1,659.59 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $288.40 / $676.08
| Professional | | $165.96 | $288.40 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $177.83 / $407.38
| Facility | | $177.83 | $177.83 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $245.47 / $389.05
| Professional | | $169.82 | $245.47 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $281.84 / $575.44
| Professional | | $169.82 | $281.84 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $501.19 / $7,079.46
| Facility | | $141.25 | $501.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $323.59 / $467.74
| Professional | | $251.19 | $323.59 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,041.74 / $3,467.37
| Facility | | $630.96 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $288.40 / $616.60
| Professional | | $165.96 | $288.40 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,288.25 / $3,090.30
| Facility | | $831.76 | $1,288.25 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $1,659.59 / $28,840.32
| Facility | | $371.54 | $1,659.59 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $288.40 / $691.83
| Professional | | $165.96 | $288.40 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,862.09 / $2,818.38
| Facility | | $630.96 | $1,862.09 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $302.00 / $549.54
| Professional | | $169.82 | $302.00 | $549.54 |