- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $2,137.96 / $5,888.44
| Facility | | $223.87 | $2,137.96 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $208.93 / $891.25
| Professional | | $87.10 | $208.93 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $141.25 / $354.81
| Professional | | $85.11 | $141.25 | $354.81 |
- 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
- $204.17 / $354.81 / $446.68
| Professional | | $204.17 | $354.81 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $229.09 / $446.68
| Professional | | $107.15 | $229.09 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $363.08 / $398.11
| Professional | | $281.84 | $363.08 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $281.84 / $426.58
| Professional | | $114.82 | $281.84 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $3,467.37 / $6,760.83
| Facility | | $977.24 | $3,467.37 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $2,041.74 / $5,754.40
| Facility | | $223.87 | $2,041.74 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $223.87 / $660.69
| Professional | | $89.13 | $223.87 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $281.84 / $512.86
| Facility | | $281.84 | $281.84 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $446.68 / $851.14
| Professional | | $269.15 | $446.68 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.50 / $234.42 / $275.42
| Facility | | $95.50 | $234.42 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $239.88 / $309.03
| Professional | | $41.69 | $239.88 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,691.53 / $5,888.44
| Facility | | $1,000.00 | $2,691.53 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $204.17 / $389.05
| Professional | | $93.33 | $204.17 | $389.05 |