- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $2,238.72 / $3,801.89
| Facility | | $181.97 | $2,238.72 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $208.93 / $501.19
| Professional | | $165.96 | $208.93 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $588.84 / $2,818.38
| Facility | | $56.23 | $588.84 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $281.84 / $707.95
| Professional | | $165.96 | $281.84 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $218.78 / $501.19
| Facility | | $218.78 | $218.78 | $501.19 |
- 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
- $190.55 / $302.00 / $549.54
| Professional | | $190.55 | $302.00 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $302.00 / $7,079.46
| Facility | | $177.83 | $302.00 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $288.40 / $389.05
| Professional | | $229.09 | $288.40 | $389.05 |
- 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
- $204.17 / $338.84 / $524.81
| Professional | | $204.17 | $338.84 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $588.84 / $2,818.38
| Facility | | $56.23 | $588.84 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $281.84 / $707.95
| Professional | | $165.96 | $281.84 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,819.70 / $2,818.38
| Facility | | $501.19 | $1,819.70 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $295.12 / $549.54
| Professional | | $186.21 | $295.12 | $549.54 |