- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $1,737.80 / $3,388.44
| Facility | | $186.21 | $1,737.80 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $208.93 / $776.25
| Professional | | $87.10 | $208.93 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,258.93 / $4,677.35
| Facility | | $56.23 | $1,258.93 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $251.19 / $691.83
| Professional | | $102.33 | $251.19 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $109.65 / $257.04
| Facility | | $109.65 | $109.65 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $218.78 / $588.84
| Professional | | $218.78 | $218.78 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $316.23 / $691.83
| Professional | | $141.25 | $316.23 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $173.78 / $8,511.38
| Facility | | $83.18 | $173.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $354.81 / $562.34
| Professional | | $281.84 | $354.81 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,630.78 / $8,511.38
| Facility | | $1,698.24 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $239.88 / $602.56
| Professional | | $100.00 | $239.88 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $2,691.53 / $3,890.45
| Facility | | $218.78 | $2,691.53 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $199.53 / $199.53
| Professional | | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,258.93 / $4,677.35
| Facility | | $56.23 | $1,258.93 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $251.19 / $676.08
| Professional | | $102.33 | $251.19 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,630.78 / $8,511.38
| Facility | | $1,584.89 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $281.84 / $602.56
| Professional | | $120.23 | $281.84 | $602.56 |