- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $2,691.53 / $3,715.35
| Facility | | $151.36 | $2,691.53 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $213.80 / $524.81
| Professional | | $85.11 | $213.80 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,258.93 / $3,801.89
| Facility | | $56.23 | $1,258.93 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $263.03 / $741.31
| Professional | | $102.33 | $263.03 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $112.20 / $263.03
| Facility | | $112.20 | $112.20 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $223.87 / $616.60
| Professional | | $223.87 | $223.87 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $346.74 / $741.31
| Professional | | $141.25 | $346.74 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.11 / $177.83 / $8,511.38
| Facility | | $85.11 | $177.83 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $371.54 / $645.65
| Professional | | $295.12 | $371.54 | $645.65 |
- 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
- $102.33 / $257.04 / $645.65
| Professional | | $102.33 | $257.04 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $1,995.26 / $1,995.26
| Facility | | $1,995.26 | $1,995.26 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,288.25 / $3,801.89
| Facility | | $56.23 | $1,288.25 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $263.03 / $741.31
| Professional | | $102.33 | $263.03 | $741.31 |
- 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
- $123.03 / $302.00 / $660.69
| Professional | | $123.03 | $302.00 | $660.69 |