- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $2,187.76 / $3,801.89
| Facility | | $602.56 | $2,187.76 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $602.56 / $2,630.27
| Professional | | $151.36 | $602.56 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $741.31 / $4,168.69
| Facility | | $56.23 | $741.31 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $645.65 / $2,398.83
| Professional | | $158.49 | $645.65 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $169.82 / $398.11
| Facility | | $169.82 | $169.82 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $954.99 / $2,041.74
| Professional | | $263.03 | $954.99 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $977.24 / $2,187.76
| Professional | | $218.78 | $977.24 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $223.87 / $7,079.46
| Facility | | $134.90 | $223.87 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,174.90 / $2,238.72
| Professional | | $977.24 | $1,174.90 | $2,238.72 |
- 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
- $165.96 / $794.33 / $1,995.26
| Professional | | $165.96 | $794.33 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,995.26 / $1,995.26
| Facility | | $1,071.52 | $1,995.26 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $954.99 / $7,244.36
| Facility | | $56.23 | $954.99 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $645.65 / $2,398.83
| Professional | | $158.49 | $645.65 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,862.09 / $2,818.38
| Facility | | $630.96 | $1,862.09 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $616.60 / $2,137.96
| Professional | | $190.55 | $616.60 | $2,137.96 |