- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $2,089.30 / $4,677.35
| Facility | | $213.80 | $2,089.30 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $245.47 / $707.95
| Professional | | $117.49 | $245.47 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $2,344.23 / $19,498.45
| Facility | | $302.00 | $2,344.23 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $263.03 / $1,778.28
| Professional | | $123.03 | $263.03 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $144.54 / $338.84
| Facility | | $144.54 | $144.54 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $331.13 / $691.83
| Professional | | $204.17 | $331.13 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $478.63 / $1,202.26
| Facility | | $100.00 | $478.63 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $269.15 / $575.44
| Professional | | $131.83 | $269.15 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $380.19 / $7,079.46
| Facility | | $123.03 | $380.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $407.38 / $575.44
| Professional | | $295.12 | $407.38 | $575.44 |
- 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
- $144.54 / $309.03 / $691.83
| Professional | | $144.54 | $309.03 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $3,981.07 / $4,570.88
| Facility | | $363.08 | $3,981.07 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $446.68 / $467.74
| Professional | | $199.53 | $446.68 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $2,344.23 / $19,498.45
| Facility | | $302.00 | $2,344.23 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $263.03 / $1,778.28
| Professional | | $123.03 | $263.03 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $3,019.95 / $8,511.38
| Facility | | $676.08 | $3,019.95 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $251.19 / $645.65
| Professional | | $123.03 | $251.19 | $645.65 |