- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $2,818.38 / $5,623.41
| Facility | | $123.03 | $2,818.38 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $223.87 / $436.52
| Professional | | $128.82 | $223.87 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $575.44 / $2,818.38
| Facility | | $56.23 | $575.44 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $309.03 / $812.83
| Professional | | $158.49 | $309.03 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $173.78 / $407.38
| Facility | | $173.78 | $173.78 | $407.38 |
- 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
- $169.82 / $323.59 / $630.96
| Professional | | $169.82 | $323.59 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $302.00 / $7,079.46
| Facility | | $134.90 | $302.00 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $436.52 / $562.34
| Professional | | $354.81 | $436.52 | $562.34 |
- 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
- $169.82 / $363.08 / $758.58
| Professional | | $169.82 | $363.08 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $575.44 / $2,818.38
| Facility | | $56.23 | $575.44 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $309.03 / $812.83
| Professional | | $158.49 | $309.03 | $812.83 |
- 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
- $165.96 / $309.03 / $691.83
| Professional | | $165.96 | $309.03 | $691.83 |