- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.79 / $2,818.38 / $5,623.41
| Facility | | $70.79 | $2,818.38 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $123.03 / $354.81
| Professional | | $83.18 | $123.03 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,047.13 / $2,818.38
| Facility | | $56.23 | $1,047.13 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $173.78 / $416.87
| Professional | | $107.15 | $173.78 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.49 / $117.49 / $269.15
| Facility | | $117.49 | $117.49 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $50.12 / $50.12
| Facility | | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $181.97 / $380.19
| Professional | | $109.65 | $181.97 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.10 / $186.21 / $7,079.46
| Facility | | $87.10 | $186.21 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $208.93 / $309.03
| Professional | | $165.96 | $208.93 | $309.03 |
- 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
- $104.71 / $190.55 / $407.38
| Professional | | $104.71 | $190.55 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,047.13 / $2,818.38
| Facility | | $56.23 | $1,047.13 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $173.78 / $426.58
| Professional | | $107.15 | $173.78 | $426.58 |
- 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
- $104.71 / $186.21 / $354.81
| Professional | | $104.71 | $186.21 | $354.81 |