- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $2,187.76 / $3,801.89
| Facility | | $177.83 | $2,187.76 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $204.17 / $562.34
| Professional | | $125.89 | $204.17 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $1,949.84 / $13,489.63
| Facility | | $363.08 | $1,949.84 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $269.15 / $676.08
| Professional | | $144.54 | $269.15 | $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
- $204.17 / $331.13 / $630.96
| Professional | | $204.17 | $331.13 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $288.40 / $575.44
| Professional | | $158.49 | $288.40 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $218.78 / $7,079.46
| Facility | | $131.83 | $218.78 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $316.23 / $446.68
| Professional | | $245.47 | $316.23 | $446.68 |
- 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
- $154.88 / $275.42 / $588.84
| Professional | | $154.88 | $275.42 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $363.08 / $363.08
| Professional | | $363.08 | $363.08 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $1,949.84 / $13,489.63
| Facility | | $363.08 | $1,949.84 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $269.15 / $691.83
| Professional | | $144.54 | $269.15 | $691.83 |
- 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
- $154.88 / $275.42 / $537.03
| Professional | | $154.88 | $275.42 | $537.03 |