- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $2,691.53 / $8,317.64
| Facility | | $138.04 | $2,691.53 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $154.88 / $512.86
| Professional | | $89.13 | $154.88 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $131.83 / $186.21
| Professional | | $112.20 | $131.83 | $186.21 |
- 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
- $223.87 / $223.87 / $223.87
| Professional | | $223.87 | $223.87 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $138.04 / $223.87
| Professional | | $93.33 | $138.04 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.05 / $114.82 / $239.88
| Professional | | $19.05 | $114.82 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $165.96 / $251.19
| Professional | | $114.82 | $165.96 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $2,344.23 / $3,801.89
| Facility | | $616.60 | $2,344.23 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $141.25 / $190.55
| Professional | | $120.23 | $141.25 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $2,454.71 / $7,762.47
| Facility | | $162.18 | $2,454.71 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $147.91 / $354.81
| Professional | | $93.33 | $147.91 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Professional | | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.69 / $102.33 / $309.03
| Facility | | $41.69 | $102.33 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $109.65 / $309.03
| Professional | | $41.69 | $109.65 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,584.89 / $3,890.45
| Facility | | $467.74 | $1,584.89 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $128.82 / $218.78
| Professional | | $89.13 | $128.82 | $218.78 |