- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $1,047.13 / $3,388.44
| Facility | | $131.83 | $1,047.13 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $338.84 / $2,089.30
| Professional | | $67.61 | $338.84 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $501.19 / $2,818.38
| Facility | | $56.23 | $501.19 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $309.03 / $1,122.02
| Professional | | $81.28 | $309.03 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.10 / $87.10 / $204.17
| Facility | | $87.10 | $87.10 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $173.78 / $891.25
| Professional | | $173.78 | $173.78 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $436.52 / $1,318.26
| Professional | | $117.49 | $436.52 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.62 / $501.19 / $7,079.46
| Facility | | $77.62 | $501.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $537.03 / $1,023.29
| Professional | | $426.58 | $537.03 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,041.74 / $3,467.37
| Facility | | $630.96 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $363.08 / $891.25
| Professional | | $79.43 | $363.08 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $1,949.84 / $3,311.31
| Facility | | $186.21 | $1,949.84 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $616.60 / $794.33
| Professional | | $154.88 | $616.60 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $501.19 / $2,818.38
| Facility | | $56.23 | $501.19 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $309.03 / $1,096.48
| Professional | | $81.28 | $309.03 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $1,862.09 / $2,818.38
| Facility | | $630.96 | $1,862.09 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $323.59 / $954.99
| Professional | | $95.50 | $323.59 | $954.99 |