- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $2,238.72 / $7,244.36
| Facility | | $120.23 | $2,238.72 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $138.04 / $436.52
| Professional | | $70.79 | $138.04 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $100.00 / $125.89
| Professional | | $46.77 | $100.00 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,398.83 / $57,543.99
| Facility | | $2,344.23 | $2,398.83 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $218.78 / $288.40
| Professional | | $190.55 | $218.78 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $117.49 / $194.98
| Professional | | $77.62 | $117.49 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.05 / $114.82 / $218.78
| Professional | | $19.05 | $114.82 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $151.36 / $223.87
| Professional | | $91.20 | $151.36 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,949.84 / $3,890.45
| Facility | | $575.44 | $1,949.84 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $125.89 / $147.91
| Professional | | $107.15 | $125.89 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $1,995.26 / $6,165.95
| Facility | | $141.25 | $1,995.26 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $128.82 / $302.00
| Professional | | $72.44 | $128.82 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $131.83 / $131.83
| Professional | | $131.83 | $131.83 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.90 / $104.71 / $190.55
| Facility | | $30.90 | $104.71 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.90 / $107.15 / $309.03
| Professional | | $30.90 | $107.15 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,548.82 / $3,890.45
| Facility | | $436.52 | $1,548.82 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $109.65 / $186.21
| Professional | | $69.18 | $109.65 | $186.21 |