- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.83 / $1,949.84 / $6,165.95
| Facility | | $0.83 | $1,949.84 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $263.03 / $691.83
| Professional | | $120.23 | $263.03 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $4,570.88 / $7,079.46
| Facility | | $2,630.27 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $446.68 / $1,174.90
| Professional | | $208.93 | $446.68 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $870.96 / $1,380.38
| Facility | | $741.31 | $870.96 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $467.74 / $1,000.00
| Professional | | $208.93 | $467.74 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $512.86 / $4,265.80
| Facility | | $158.49 | $512.86 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $436.52 / $812.83
| Professional | | $275.42 | $436.52 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $537.03 / $5,623.41
| Facility | | $151.36 | $537.03 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $537.03 / $2,041.74
| Professional | | $275.42 | $537.03 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $436.52
| Professional | | $32.36 | $33.11 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $436.52 / $1,047.13
| Professional | | $234.42 | $436.52 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $4,466.84 / $4,466.84
| Facility | | $3,019.95 | $4,466.84 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $588.84 / $1,995.26
| Professional | | $177.83 | $588.84 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $776.25 / $1,659.59
| Professional | | $575.44 | $776.25 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,801.89 / $6,456.54
| Facility | | $2,884.03 | $3,801.89 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $398.11 / $1,023.29
| Professional | | $158.49 | $398.11 | $1,023.29 |