- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $2,238.72 / $3,801.89
| Facility | | $141.25 | $2,238.72 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $141.25 / $316.23
| Professional | | $60.26 | $141.25 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $954.99 / $2,818.38
| Facility | | $56.23 | $954.99 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $173.78 / $870.96
| Professional | | $66.07 | $173.78 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $69.18 / $69.18 / $162.18
| Facility | | $69.18 | $69.18 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $181.97 / $416.87
| Professional | | $69.18 | $181.97 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $151.36 / $407.38
| Professional | | $69.18 | $151.36 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $109.65 / $8,511.38
| Facility | | $56.23 | $109.65 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $229.09 / $380.19
| Professional | | $177.83 | $229.09 | $380.19 |
- 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
- $63.10 / $158.49 / $371.54
| Professional | | $63.10 | $158.49 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,000.00 / $2,818.38
| Facility | | $56.23 | $1,000.00 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $169.82 / $870.96
| Professional | | $66.07 | $169.82 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,862.09 / $2,818.38
| Facility | | $501.19 | $1,862.09 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $165.96 / $416.87
| Professional | | $69.18 | $165.96 | $416.87 |