- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $2,238.72 / $3,801.89
| Facility | | $218.78 | $2,238.72 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $204.17 / $416.87
| Professional | | $95.50 | $204.17 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $776.25 / $4,570.88
| Facility | | $56.23 | $776.25 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $229.09 / $645.65
| Professional | | $102.33 | $229.09 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $112.20 / $263.03
| Facility | | $112.20 | $112.20 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $257.04 / $478.63
| Professional | | $128.82 | $257.04 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $676.08 / $741.31
| Facility | | $257.04 | $676.08 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $257.04 / $524.81
| Professional | | $114.82 | $257.04 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $380.19 / $7,079.46
| Facility | | $83.18 | $380.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $338.84 / $478.63
| Professional | | $234.42 | $338.84 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $3,162.28 / $8,511.38
| Facility | | $616.60 | $3,162.28 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $229.09 / $549.54
| Professional | | $100.00 | $229.09 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $776.25 / $4,570.88
| Facility | | $56.23 | $776.25 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $229.09 / $676.08
| Professional | | $102.33 | $229.09 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $2,691.53 / $8,511.38
| Facility | | $676.08 | $2,691.53 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $223.87 / $512.86
| Professional | | $102.33 | $223.87 | $512.86 |