- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,090.75 / $1,236.18 / $1,454.33
| Facility | | $1,090.75 | $1,236.18 | $1,454.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.15 / $1,059.07 / $1,483.42
| Professional | | $31.15 | $1,059.07 | $1,483.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.68 / $177.48 / $177.48
| Facility | | $27.68 | $177.48 | $177.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.44 / $1,582.94 / $4,016.47
| Professional | | $76.44 | $1,582.94 | $4,016.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.46 / $1,611.99 / $1,991.21
| Facility | | $40.46 | $1,611.99 | $1,991.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.10 / $1,563.33 / $2,806.02
| Professional | | $51.10 | $1,563.33 | $2,806.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.61 / $46.61 / $46.61
| Facility | | $46.61 | $46.61 | $46.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,077.57 / $1,077.57 / $1,077.57
| Professional | | $1,077.57 | $1,077.57 | $1,077.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.78 / $34.78 / $44.33
| Facility | | $34.78 | $34.78 | $44.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,424.19 / $1,799.62 / $2,664.62
| Professional | | $1,424.19 | $1,799.62 | $2,664.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.07 / $964.05 / $3,296.92
| Professional | | $60.07 | $964.05 | $3,296.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.48 / $177.48 / $177.48
| Facility | | $177.48 | $177.48 | $177.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.74 / $1,784.66 / $7,170.93
| Professional | | $222.74 | $1,784.66 | $7,170.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $998.03 / $1,540.62 / $2,518.83
| Professional | | $998.03 | $1,540.62 | $2,518.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,211.44 / $1,808.38 / $3,397.96
| Professional | | $1,211.44 | $1,808.38 | $3,397.96 |