- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.47 / $2,960.62 / $6,865.70
| Facility | | $263.47 | $2,960.62 | $6,865.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.76 / $338.79 / $850.68
| Professional | | $175.76 | $338.79 | $850.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.74 / $271.70 / $529.59
| Professional | | $157.74 | $271.70 | $529.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,704.83 / $1,704.83 / $1,729.70
| Facility | | $1,704.83 | $1,704.83 | $1,729.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.00 / $669.02 / $1,373.98
| Professional | | $312.00 | $669.02 | $1,373.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.04 / $530.04 / $2,710.28
| Facility | | $530.04 | $530.04 | $2,710.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.83 / $558.59 / $1,176.84
| Professional | | $282.83 | $558.59 | $1,176.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.03 / $501.54 / $994.00
| Facility | | $181.03 | $501.54 | $994.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.00 / $708.00 / $708.00
| Professional | | $378.00 | $708.00 | $708.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $384.40 / $1,553.30
| Professional | | $3.00 | $384.40 | $1,553.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,711.00 / $7,162.00 / $10,397.00
| Facility | | $1,711.00 | $7,162.00 | $10,397.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.05 / $639.54 / $1,212.67
| Professional | | $436.05 | $639.54 | $1,212.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $972.88 / $1,039.42 / $16,394.00
| Facility | | $972.88 | $1,039.42 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,906.60 / $2,728.60 / $3,336.50
| Professional | | $1,906.60 | $2,728.60 | $3,336.50 |