- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $2,630.27 / $8,128.31
| Facility | | $478.63 | $2,630.27 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $120.23 / $489.78
| Professional | | $57.54 | $120.23 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $112.20 / $128.82
| Professional | | $109.65 | $112.20 | $128.82 |
- 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
- $186.21 / $186.21 / $204.17
| Professional | | $186.21 | $186.21 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $120.23 / $199.53
| Professional | | $60.26 | $120.23 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $186.21 / $204.17
| Professional | | $144.54 | $186.21 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $151.36 / $208.93
| Professional | | $95.50 | $151.36 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,737.80 / $3,311.31
| Facility | | $1,047.13 | $1,737.80 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $117.49 / $165.96
| Professional | | $109.65 | $117.49 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,290.87 / $7,762.47
| Facility | | $537.03 | $2,290.87 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $123.03 / $309.03
| Professional | | $58.88 | $123.03 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $107.15 / $107.15
| Professional | | $107.15 | $107.15 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58.88 / $120.23 / $309.03
| Facility | | $58.88 | $120.23 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $117.49 / $309.03
| Professional | | $45.71 | $117.49 | $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
- $56.23 / $107.15 / $181.97
| Professional | | $56.23 | $107.15 | $181.97 |