- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $2,691.53 / $8,317.64
| Facility | | $616.60 | $2,691.53 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $162.18 / $426.58
| Professional | | $102.33 | $162.18 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,258.93 / $57,543.99
| Facility | | $1,174.90 | $1,258.93 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $302.00 / $302.00
| Professional | | $151.36 | $302.00 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $173.78 / $281.84
| Professional | | $109.65 | $173.78 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $269.15 / $295.12
| Professional | | $208.93 | $269.15 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $208.93 / $309.03
| Professional | | $138.04 | $208.93 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $177.83 / $190.55
| Professional | | $173.78 | $177.83 | $190.55 |
- 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
- $107.15 / $169.82 / $398.11
| Professional | | $107.15 | $169.82 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $162.18 / $162.18
| Professional | | $162.18 | $162.18 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.86 / $114.82 / $173.78
| Facility | | $75.86 | $114.82 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $120.23 / $309.03
| Professional | | $75.86 | $120.23 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $630.96 / $3,890.45
| Facility | | $223.87 | $630.96 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $158.49 / $275.42
| Professional | | $102.33 | $158.49 | $275.42 |