- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $1,122.02 / $1,905.46
| Facility | | $380.19 | $1,122.02 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $223.87 / $302.00
| Professional | | $162.18 | $223.87 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,380.38 / $1,380.38
| Facility | | $691.83 | $1,380.38 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $295.12 / $602.56
| Professional | | $229.09 | $295.12 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $616.60 / $776.25
| Facility | | $199.53 | $616.60 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $208.93 / $457.09
| Professional | | $162.18 | $208.93 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $389.05 / $912.01
| Facility | | $186.21 | $389.05 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $302.00 / $416.87
| Professional | | $275.42 | $302.00 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $302.00 / $478.63
| Professional | | $245.47 | $302.00 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $1,318.26
| Facility | | $1,318.26 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,041.74 / $2,041.74
| Professional | | $1,380.38 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $331.13 / $724.44
| Facility | | $208.93 | $331.13 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $302.00 / $302.00
| Professional | | $275.42 | $302.00 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $309.03 / $4,168.69
| Professional | | $218.78 | $309.03 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $275.42 / $275.42
| Facility | | $114.82 | $275.42 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $114.82 / $524.81
| Professional | | $114.82 | $114.82 | $524.81 |