- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $2,754.23 / $5,623.41
| Facility | | $281.84 | $2,754.23 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $269.15 / $645.65
| Professional | | $117.49 | $269.15 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,047.13 / $3,548.13
| Facility | | $56.23 | $1,047.13 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $302.00 / $812.83
| Professional | | $128.82 | $302.00 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $138.04 / $323.59
| Facility | | $138.04 | $138.04 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $331.13 / $741.31
| Professional | | $138.04 | $331.13 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $288.40 / $676.08
| Professional | | $154.88 | $288.40 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $218.78 / $7,079.46
| Facility | | $104.71 | $218.78 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $407.38 / $616.60
| Professional | | $323.59 | $407.38 | $616.60 |
- 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
- $125.89 / $316.23 / $691.83
| Professional | | $125.89 | $316.23 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,047.13 / $3,801.89
| Facility | | $56.23 | $1,047.13 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $302.00 / $831.76
| Professional | | $128.82 | $302.00 | $831.76 |
- 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
- $138.04 / $316.23 / $707.95
| Professional | | $138.04 | $316.23 | $707.95 |