- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $2,238.72 / $3,801.89
| Facility | | $186.21 | $2,238.72 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $213.80 / $575.44
| Professional | | $144.54 | $213.80 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $758.58 / $4,265.80
| Facility | | $56.23 | $758.58 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $288.40 / $707.95
| Professional | | $169.82 | $288.40 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $199.53 / $446.68
| Facility | | $199.53 | $199.53 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $426.58 / $676.08
| Professional | | $257.04 | $426.58 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $302.00 / $630.96
| Professional | | $186.21 | $302.00 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $501.19 / $7,079.46
| Facility | | $144.54 | $501.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $331.13 / $467.74
| Professional | | $251.19 | $331.13 | $467.74 |
- 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
- $165.96 / $288.40 / $616.60
| Professional | | $165.96 | $288.40 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $758.58 / $4,265.80
| Facility | | $56.23 | $758.58 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $295.12 / $724.44
| Professional | | $169.82 | $295.12 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,819.70 / $2,818.38
| Facility | | $575.44 | $1,819.70 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $302.00 / $588.84
| Professional | | $169.82 | $302.00 | $588.84 |