- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $2,238.72 / $3,801.89
| Facility | | $102.33 | $2,238.72 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $144.54 / $346.74
| Professional | | $89.13 | $144.54 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $537.03 / $2,818.38
| Facility | | $56.23 | $537.03 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $173.78 / $371.54
| Professional | | $91.20 | $173.78 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.72 / $97.72 / $223.87
| Facility | | $97.72 | $97.72 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $218.78 / $302.00
| Professional | | $144.54 | $218.78 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $223.87 / $457.09
| Professional | | $134.90 | $223.87 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $177.83 / $7,079.46
| Facility | | $79.43 | $177.83 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $208.93 / $338.84
| Professional | | $169.82 | $208.93 | $338.84 |
- 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
- $95.50 / $169.82 / $363.08
| Professional | | $95.50 | $169.82 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $537.03 / $2,818.38
| Facility | | $56.23 | $537.03 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $173.78 / $371.54
| Professional | | $91.20 | $173.78 | $371.54 |
- 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
- $107.15 / $204.17 / $380.19
| Professional | | $107.15 | $204.17 | $380.19 |