- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $2,238.72 / $3,801.89
| Facility | | $478.63 | $2,238.72 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $398.11 / $812.83
| Professional | | $204.17 | $398.11 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $2,344.23 / $19,498.45
| Facility | | $467.74 | $2,344.23 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $467.74 / $2,884.03
| Professional | | $223.87 | $467.74 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $295.12 / $676.08
| Facility | | $295.12 | $295.12 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $851.14 / $851.14
| Professional | | $630.96 | $851.14 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $501.19 / $1,995.26
| Facility | | $446.68 | $501.19 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $436.52 / $977.24
| Professional | | $223.87 | $436.52 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $398.11 / $7,079.46
| Facility | | $190.55 | $398.11 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $676.08 / $1,023.29
| Professional | | $489.78 | $676.08 | $1,023.29 |
- 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
- $223.87 / $489.78 / $1,148.15
| Professional | | $223.87 | $489.78 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $2,344.23 / $19,498.45
| Facility | | $467.74 | $2,344.23 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $467.74 / $2,884.03
| Professional | | $223.87 | $467.74 | $2,884.03 |
- 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
- $223.87 / $467.74 / $1,071.52
| Professional | | $223.87 | $467.74 | $1,071.52 |