- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $2,238.72 / $3,715.35
| Facility | | $223.87 | $2,238.72 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $245.47 / $660.69
| Professional | | $173.78 | $245.47 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $3,630.78 / $19,498.45
| Facility | | $416.87 | $3,630.78 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $302.00 / $691.83
| Professional | | $169.82 | $302.00 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $208.93 / $467.74
| Facility | | $208.93 | $208.93 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $363.08 / $758.58
| Professional | | $213.80 | $363.08 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $257.04 / $7,079.46
| Facility | | $154.88 | $257.04 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $251.19 / $389.05
| Professional | | $138.04 | $251.19 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,630.78 / $8,511.38
| Facility | | $1,698.24 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $309.03 / $588.84
| Professional | | $181.97 | $309.03 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $4,265.80 / $4,265.80
| Facility | | $4,265.80 | $4,265.80 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $3,630.78 / $19,498.45
| Facility | | $416.87 | $3,630.78 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $295.12 / $676.08
| Professional | | $169.82 | $295.12 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,630.78 / $8,511.38
| Facility | | $1,584.89 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $338.84 / $660.69
| Professional | | $181.97 | $338.84 | $660.69 |