- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,691.53 / $4,897.79
| Facility | | $398.11 | $2,691.53 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $371.54 / $1,047.13
| Professional | | $158.49 | $371.54 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,862.09 / $6,025.60
| Facility | | $56.23 | $1,862.09 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $416.87 / $1,122.02
| Professional | | $169.82 | $416.87 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $186.21 / $436.52
| Facility | | $186.21 | $186.21 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $478.63 / $1,071.52
| Professional | | $208.93 | $478.63 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $380.19 / $7,079.46
| Facility | | $147.91 | $380.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $407.38 / $660.69
| Professional | | $218.78 | $407.38 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,511.89 / $7,079.46
| Facility | | $1,096.48 | $2,511.89 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $407.38 / $891.25
| Professional | | $173.78 | $407.38 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $1,737.80 / $1,737.80
| Facility | | $1,737.80 | $1,737.80 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,949.84 / $6,025.60
| Facility | | $56.23 | $1,949.84 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $416.87 / $1,122.02
| Professional | | $169.82 | $416.87 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $2,511.89 / $6,918.31
| Facility | | $1,047.13 | $2,511.89 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $436.52 / $977.24
| Professional | | $186.21 | $436.52 | $977.24 |