- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $2,818.38 / $5,623.41
| Facility | | $162.18 | $2,818.38 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $263.03 / $512.86
| Professional | | $162.18 | $263.03 | $512.86 |
- 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
- $190.55 / $346.74 / $933.25
| Professional | | $190.55 | $346.74 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $213.80 / $489.78
| Facility | | $213.80 | $213.80 | $489.78 |
- 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
- $204.17 / $371.54 / $724.44
| Professional | | $204.17 | $371.54 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $302.00 / $7,079.46
| Facility | | $158.49 | $302.00 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $489.78 / $616.60
| Professional | | $398.11 | $489.78 | $616.60 |
- 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 / $407.38 / $851.14
| Professional | | $204.17 | $407.38 | $851.14 |
- 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
- $190.55 / $346.74 / $933.25
| Professional | | $190.55 | $346.74 | $933.25 |
- 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
- $199.53 / $354.81 / $794.33
| Professional | | $199.53 | $354.81 | $794.33 |