- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $2,818.38 / $4,897.79
| Facility | | $177.83 | $2,818.38 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $257.04 / $707.95
| Professional | | $112.20 | $257.04 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $3,388.44 / $28,840.32
| Facility | | $288.40 | $3,388.44 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $288.40 / $831.76
| Professional | | $128.82 | $288.40 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $141.25 / $323.59
| Facility | | $141.25 | $141.25 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $239.88 / $562.34
| Professional | | $239.88 | $239.88 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $346.74 / $794.33
| Professional | | $169.82 | $346.74 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $501.19 / $7,079.46
| Facility | | $107.15 | $501.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $398.11 / $562.34
| Professional | | $316.23 | $398.11 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,630.78 / $8,511.38
| Facility | | $1,698.24 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $288.40 / $691.83
| Professional | | $125.89 | $288.40 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $3,548.13 / $28,840.32
| Facility | | $288.40 | $3,548.13 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $288.40 / $812.83
| Professional | | $128.82 | $288.40 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,630.78 / $8,511.38
| Facility | | $1,584.89 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $288.40 / $707.95
| Professional | | $147.91 | $288.40 | $707.95 |