- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $2,691.53 / $3,715.35
| Facility | | $134.90 | $2,691.53 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $114.82 / $309.03
| Professional | | $53.70 | $114.82 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $346.74 / $2,818.38
| Facility | | $56.23 | $346.74 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $125.89 / $316.23
| Professional | | $57.54 | $125.89 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.54 / $57.54 / $134.90
| Facility | | $57.54 | $57.54 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $128.82 / $269.15
| Professional | | $67.61 | $128.82 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $177.83 / $7,079.46
| Facility | | $56.23 | $177.83 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $177.83 / $251.19
| Professional | | $144.54 | $177.83 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,041.74 / $3,467.37
| Facility | | $630.96 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $128.82 / $316.23
| Professional | | $58.88 | $128.82 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $776.25 / $776.25
| Facility | | $776.25 | $776.25 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $346.74 / $2,818.38
| Facility | | $56.23 | $346.74 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $125.89 / $316.23
| Professional | | $57.54 | $125.89 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,862.09 / $2,818.38
| Facility | | $630.96 | $1,862.09 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $134.90 / $302.00
| Professional | | $63.10 | $134.90 | $302.00 |