- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $2,187.76 / $3,801.89
| Facility | | $257.04 | $2,187.76 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $245.47 / $630.96
| Professional | | $112.20 | $245.47 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,096.48 / $3,801.89
| Facility | | $56.23 | $1,096.48 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $281.84 / $741.31
| Professional | | $125.89 | $281.84 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $131.83 / $309.03
| Facility | | $131.83 | $131.83 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $302.00 / $676.08
| Professional | | $131.83 | $302.00 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $275.42 / $630.96
| Professional | | $147.91 | $275.42 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $213.80 / $7,079.46
| Facility | | $102.33 | $213.80 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $380.19 / $562.34
| Professional | | $295.12 | $380.19 | $562.34 |
- 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
- $123.03 / $295.12 / $630.96
| Professional | | $123.03 | $295.12 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $2,570.40 / $3,890.45
| Facility | | $2,570.40 | $2,570.40 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,096.48 / $3,801.89
| Facility | | $56.23 | $1,096.48 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $281.84 / $758.58
| Professional | | $125.89 | $281.84 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,238.72 / $6,165.95
| Facility | | $794.33 | $2,238.72 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $295.12 / $645.65
| Professional | | $134.90 | $295.12 | $645.65 |