- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $2,041.74 / $6,606.93
| Facility | | $239.88 | $2,041.74 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $158.49 / $549.54
| Professional | | $77.62 | $158.49 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $120.23 / $177.83
| Professional | | $66.07 | $120.23 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,570.40 / $57,543.99
| Facility | | $2,344.23 | $2,570.40 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $165.96 / $269.15
| Professional | | $107.15 | $165.96 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $181.97 / $288.40
| Professional | | $28.84 | $181.97 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $199.53 / $302.00
| Professional | | $131.83 | $199.53 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,737.80 / $3,388.44
| Facility | | $891.25 | $1,737.80 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $169.82 / $190.55
| Professional | | $147.91 | $169.82 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $162.18 / $208.93
| Professional | | $162.18 | $162.18 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $1,778.28 / $6,165.95
| Facility | | $239.88 | $1,778.28 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $165.96 / $398.11
| Professional | | $93.33 | $165.96 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $173.78 / $173.78
| Professional | | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $154.88 / $309.03
| Facility | | $30.20 | $154.88 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $165.96 / $309.03
| Professional | | $30.20 | $165.96 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,584.89 / $3,890.45
| Facility | | $436.52 | $1,584.89 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $151.36 / $263.03
| Professional | | $97.72 | $151.36 | $263.03 |