- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $2,238.72 / $3,801.89
| Facility | | $416.87 | $2,238.72 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $446.68 / $954.99
| Professional | | $295.12 | $446.68 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,454.71 / $5,754.40
| Facility | | $56.23 | $2,454.71 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $549.54 / $3,388.44
| Professional | | $323.59 | $549.54 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $380.19 / $870.96
| Facility | | $380.19 | $380.19 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $676.08 / $741.31
| Facility | | $100.00 | $676.08 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $524.81 / $1,096.48
| Professional | | $295.12 | $524.81 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $478.63 / $7,079.46
| Facility | | $177.83 | $478.63 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $758.58 / $1,047.13
| Professional | | $549.54 | $758.58 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $3,801.89 / $9,772.37
| Facility | | $524.81 | $3,801.89 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $645.65 / $1,288.25
| Professional | | $354.81 | $645.65 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,454.71 / $5,754.40
| Facility | | $56.23 | $2,454.71 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $549.54 / $3,388.44
| Professional | | $323.59 | $549.54 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $3,890.45 / $9,549.93
| Facility | | $1,071.52 | $3,890.45 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $562.34 / $1,230.27
| Professional | | $316.23 | $562.34 | $1,230.27 |