- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $2,041.74 / $3,801.89
| Facility | | $114.82 | $2,041.74 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $144.54 / $436.52
| Professional | | $70.79 | $144.54 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $1,949.84 / $13,489.63
| Facility | | $208.93 | $1,949.84 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $151.36 / $380.19
| Professional | | $83.18 | $151.36 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $102.33 / $234.42
| Facility | | $102.33 | $102.33 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $181.97 / $338.84
| Professional | | $102.33 | $181.97 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $158.49 / $323.59
| Professional | | $91.20 | $158.49 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $177.83 / $7,079.46
| Facility | | $79.43 | $177.83 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $177.83 / $251.19
| Professional | | $138.04 | $177.83 | $251.19 |
- 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
- $93.33 / $154.88 / $331.13
| Professional | | $93.33 | $154.88 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $724.44 / $4,466.84
| Facility | | $151.36 | $724.44 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $199.53 / $363.08
| Professional | | $173.78 | $199.53 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $1,949.84 / $13,489.63
| Facility | | $208.93 | $1,949.84 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $154.88 / $389.05
| Professional | | $83.18 | $154.88 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,344.23 / $6,165.95
| Facility | | $954.99 | $2,344.23 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $158.49 / $302.00
| Professional | | $85.11 | $158.49 | $302.00 |