- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $2,238.72 / $3,801.89
| Facility | | $288.40 | $2,238.72 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $269.15 / $630.96
| Professional | | $91.20 | $269.15 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $3,981.07 / $19,498.45
| Facility | | $229.09 | $3,981.07 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $316.23 / $2,290.87
| Professional | | $102.33 | $316.23 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $109.65 / $257.04
| Facility | | $109.65 | $109.65 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $354.81 / $691.83
| Professional | | $109.65 | $354.81 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $478.63 / $3,090.30
| Facility | | $446.68 | $478.63 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $263.03 / $707.95
| Professional | | $112.20 | $263.03 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $380.19 / $7,079.46
| Facility | | $91.20 | $380.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $549.54 / $776.25
| Professional | | $398.11 | $549.54 | $776.25 |
- 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
- $109.65 / $371.54 / $933.25
| Professional | | $109.65 | $371.54 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $3,981.07 / $19,498.45
| Facility | | $229.09 | $3,981.07 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $316.23 / $2,290.87
| Professional | | $102.33 | $316.23 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $3,890.45 / $9,120.11
| Facility | | $1,071.52 | $3,890.45 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $275.42 / $851.14
| Professional | | $107.15 | $275.42 | $851.14 |