- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $2,238.72 / $3,801.89
| Facility | | $147.91 | $2,238.72 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $169.82 / $478.63
| Professional | | $131.83 | $169.82 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $4,897.79 / $19,498.45
| Facility | | $380.19 | $4,897.79 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $229.09 / $562.34
| Professional | | $141.25 | $229.09 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $186.21 / $416.87
| Facility | | $186.21 | $186.21 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $501.19 / $588.84
| Professional | | $288.40 | $501.19 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $288.40 / $575.44
| Professional | | $173.78 | $288.40 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $380.19 / $7,079.46
| Facility | | $144.54 | $380.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $199.53 / $316.23
| Professional | | $112.20 | $199.53 | $316.23 |
- 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
- $169.82 / $275.42 / $478.63
| Professional | | $169.82 | $275.42 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $4,897.79 / $19,498.45
| Facility | | $380.19 | $4,897.79 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $229.09 / $549.54
| Professional | | $141.25 | $229.09 | $549.54 |
- 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
- $169.82 / $245.47 / $537.03
| Professional | | $169.82 | $245.47 | $537.03 |