- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $114.82 / $17,782.79
| Facility | | $114.82 | $114.82 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $186.21 / $223.87
| Professional | | $120.23 | $186.21 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $4,570.88 / $7,079.46
| Facility | | $2,630.27 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $363.08 / $912.01
| Professional | | $186.21 | $363.08 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $870.96 / $1,412.54
| Facility | | $758.58 | $870.96 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $323.59 / $389.05
| Professional | | $316.23 | $323.59 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $3,235.94 / $5,888.44
| Facility | | $177.83 | $3,235.94 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $3,801.89 / $6,309.57
| Facility | | $281.84 | $3,801.89 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $323.59 / $954.99
| Professional | | $194.98 | $323.59 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $54.95 / $70.79
| Professional | | $50.12 | $54.95 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $794.33 / $4,897.79
| Professional | | $204.17 | $794.33 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $4,677.35
| Facility | | $3,235.94 | $3,235.94 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $1,862.09 / $1,862.09
| Professional | | $269.15 | $1,862.09 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $346.74 / $4,168.69
| Professional | | $346.74 | $346.74 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $5,011.87 / $8,709.64
| Professional | | $588.84 | $5,011.87 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,801.89 / $6,456.54
| Facility | | $2,884.03 | $3,801.89 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $309.03 / $870.96
| Professional | | $190.55 | $309.03 | $870.96 |