- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $3,630.78 / $8,317.64
| Facility | | $398.11 | $3,630.78 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $208.93 / $512.86
| Professional | | $131.83 | $208.93 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $2,691.53 / $57,543.99
| Facility | | $2,630.27 | $2,691.53 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $389.05 / $389.05
| Professional | | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $229.09 / $371.54
| Professional | | $141.25 | $229.09 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $229.09 / $407.38
| Professional | | $95.50 | $229.09 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $281.84 / $416.87
| Professional | | $186.21 | $281.84 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,202.26 / $3,162.28
| Facility | | $707.95 | $1,202.26 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $229.09 / $251.19
| Professional | | $218.78 | $229.09 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $2,630.27 / $8,317.64
| Facility | | $575.44 | $2,630.27 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $229.09 / $549.54
| Professional | | $138.04 | $229.09 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $239.88 / $239.88
| Professional | | $239.88 | $239.88 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $208.93 / $309.03
| Facility | | $151.36 | $208.93 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $223.87 / $309.03
| Professional | | $147.91 | $223.87 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,584.89 / $3,890.45
| Facility | | $467.74 | $1,584.89 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $208.93 / $354.81
| Professional | | $134.90 | $208.93 | $354.81 |