- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $2,691.53 / $4,897.79
| Facility | | $263.03 | $2,691.53 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $263.03 / $537.03
| Professional | | $165.96 | $263.03 | $537.03 |
- 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
- $194.98 / $331.13 / $851.14
| Professional | | $194.98 | $331.13 | $851.14 |
- 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
- $194.98 / $363.08 / $676.08
| Professional | | $194.98 | $363.08 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $302.00 / $7,079.46
| Facility | | $169.82 | $302.00 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $446.68 / $588.84
| Professional | | $363.08 | $446.68 | $588.84 |
- 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 / $380.19 / $776.25
| Professional | | $204.17 | $380.19 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $776.25 / $776.25
| Facility | | $776.25 | $776.25 | $776.25 |
- 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
- $194.98 / $331.13 / $851.14
| Professional | | $194.98 | $331.13 | $851.14 |
- 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
- $204.17 / $346.74 / $741.31
| Professional | | $204.17 | $346.74 | $741.31 |