- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $2,238.72 / $3,801.89
| Facility | | $223.87 | $2,238.72 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $281.84 / $691.83
| Professional | | $123.03 | $281.84 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $1,023.29 / $19,498.45
| Facility | | $309.03 | $1,023.29 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $346.74 / $1,122.02
| Professional | | $141.25 | $346.74 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $354.81
| Facility | | $151.36 | $151.36 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $257.04 / $794.33
| Professional | | $257.04 | $257.04 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $426.58 / $1,047.13
| Professional | | $190.55 | $426.58 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $380.19 / $7,079.46
| Facility | | $120.23 | $380.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $616.60 / $812.83
| Professional | | $489.78 | $616.60 | $812.83 |
- 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
- $144.54 / $416.87 / $1,023.29
| Professional | | $144.54 | $416.87 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $1,071.52 / $19,498.45
| Facility | | $323.59 | $1,071.52 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $338.84 / $1,071.52
| Professional | | $141.25 | $338.84 | $1,071.52 |
- 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
- $169.82 / $338.84 / $954.99
| Professional | | $169.82 | $338.84 | $954.99 |