- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $2,238.72 / $3,801.89
| Facility | | $151.36 | $2,238.72 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $169.82 / $489.78
| Professional | | $104.71 | $169.82 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $2,570.40 / $13,489.63
| Facility | | $302.00 | $2,570.40 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $229.09 / $588.84
| Professional | | $109.65 | $229.09 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $147.91 / $331.13
| Facility | | $147.91 | $147.91 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $331.13 / $549.54
| Professional | | $190.55 | $331.13 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $239.88 / $501.19
| Professional | | $128.82 | $239.88 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $218.78 / $7,079.46
| Facility | | $112.20 | $218.78 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $275.42 / $389.05
| Professional | | $213.80 | $275.42 | $389.05 |
- 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
- $131.83 / $239.88 / $512.86
| Professional | | $131.83 | $239.88 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $870.96 / $6,309.57
| Facility | | $870.96 | $870.96 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $2,570.40 / $13,489.63
| Facility | | $302.00 | $2,570.40 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $229.09 / $602.56
| Professional | | $109.65 | $229.09 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $2,511.89 / $6,165.95
| Facility | | $1,047.13 | $2,511.89 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $234.42 / $457.09
| Professional | | $120.23 | $234.42 | $457.09 |