- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $2,691.53 / $3,715.35
| Facility | | $104.71 | $2,691.53 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $169.82 / $467.74
| Professional | | $89.13 | $169.82 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $1,949.84 / $13,489.63
| Facility | | $269.15 | $1,949.84 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $173.78 / $426.58
| Professional | | $109.65 | $173.78 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $131.83 / $302.00
| Facility | | $131.83 | $131.83 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $229.09 / $398.11
| Professional | | $131.83 | $229.09 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $186.21 / $389.05
| Professional | | $112.20 | $186.21 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $218.78 / $7,079.46
| Facility | | $100.00 | $218.78 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $194.98 / $281.84
| Professional | | $151.36 | $194.98 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,511.89 / $7,079.46
| Facility | | $1,096.48 | $2,511.89 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $190.55 / $371.54
| Professional | | $117.49 | $190.55 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $707.95 / $6,165.95
| Facility | | $144.54 | $707.95 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $204.17 / $263.03
| Professional | | $97.72 | $204.17 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $1,949.84 / $13,489.63
| Facility | | $269.15 | $1,949.84 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $177.83 / $436.52
| Professional | | $109.65 | $177.83 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,344.23 / $6,165.95
| Facility | | $954.99 | $2,344.23 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $181.97 / $363.08
| Professional | | $109.65 | $181.97 | $363.08 |