- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $2,238.72 / $4,168.69
| Facility | | $204.17 | $2,238.72 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $309.03 / $660.69
| Professional | | $144.54 | $309.03 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,862.09 / $50,118.72
| Facility | | $302.00 | $1,862.09 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $323.59 / $831.76
| Professional | | $134.90 | $323.59 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $144.54 / $338.84
| Facility | | $144.54 | $144.54 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $331.13 / $602.56
| Professional | | $213.80 | $331.13 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $416.87 / $870.96
| Professional | | $199.53 | $416.87 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.49 / $380.19 / $7,079.46
| Facility | | $117.49 | $380.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $416.87 / $776.25
| Professional | | $338.84 | $416.87 | $776.25 |
- 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
- $141.25 / $323.59 / $724.44
| Professional | | $141.25 | $323.59 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,862.09 / $50,118.72
| Facility | | $302.00 | $1,862.09 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $323.59 / $831.76
| Professional | | $134.90 | $323.59 | $831.76 |
- 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
- $177.83 / $371.54 / $776.25
| Professional | | $177.83 | $371.54 | $776.25 |