- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $2,691.53 / $4,897.79
| Facility | | $724.44 | $2,691.53 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $588.84 / $1,548.82
| Professional | | $173.78 | $588.84 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $3,981.07 / $28,840.32
| Facility | | $407.38 | $3,981.07 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $588.84 / $2,398.83
| Professional | | $181.97 | $588.84 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $194.98 / $457.09
| Facility | | $194.98 | $194.98 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $741.31 / $2,344.23
| Professional | | $223.87 | $741.31 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $501.19 / $7,079.46
| Facility | | $154.88 | $501.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $870.96 / $1,445.44
| Professional | | $467.74 | $870.96 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,265.80 / $9,772.37
| Facility | | $1,995.26 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $741.31 / $1,905.46
| Professional | | $181.97 | $741.31 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,019.95 / $3,019.95
| Facility | | $3,019.95 | $3,019.95 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $4,265.80 / $28,840.32
| Facility | | $407.38 | $4,265.80 | $28,840.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $588.84 / $2,290.87
| Professional | | $181.97 | $588.84 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,265.80 / $9,772.37
| Facility | | $1,862.09 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $676.08 / $2,137.96
| Professional | | $218.78 | $676.08 | $2,137.96 |