- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.33 / $2,187.76 / $3,801.89
| Facility | | $93.33 | $2,187.76 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $114.82 / $363.08
| Professional | | $75.86 | $114.82 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $489.78 / $2,818.38
| Facility | | $56.23 | $489.78 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $141.25 / $346.74
| Professional | | $83.18 | $141.25 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.50 / $95.50 / $213.80
| Facility | | $95.50 | $95.50 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $173.78 / $331.13
| Professional | | $109.65 | $173.78 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $165.96 / $295.12
| Professional | | $87.10 | $165.96 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.86 / $162.18 / $8,511.38
| Facility | | $75.86 | $162.18 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $177.83 / $223.87
| Professional | | $144.54 | $177.83 | $223.87 |
- 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
- $89.13 / $162.18 / $323.59
| Professional | | $89.13 | $162.18 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $5,370.32 / $5,370.32
| Facility | | $5,370.32 | $5,370.32 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $199.53
| Professional | | $151.36 | $151.36 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $489.78 / $2,818.38
| Facility | | $56.23 | $489.78 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $141.25 / $338.84
| Professional | | $85.11 | $141.25 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,819.70 / $2,818.38
| Facility | | $501.19 | $1,819.70 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $151.36 / $316.23
| Professional | | $89.13 | $151.36 | $316.23 |