- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,691.53 / $7,762.47
| Facility | | $537.03 | $2,691.53 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $181.97 / $588.84
| Professional | | $87.10 | $181.97 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $162.18 / $162.18
| Professional | | $162.18 | $162.18 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,570.40 / $57,543.99
| Facility | | $2,344.23 | $2,570.40 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $331.13 / $331.13
| Professional | | $134.90 | $331.13 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $169.82 / $323.59
| Professional | | $97.72 | $169.82 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $263.03 / $288.40
| Professional | | $204.17 | $263.03 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $194.98 / $275.42
| Professional | | $100.00 | $194.98 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,584.89 / $13,489.63
| Facility | | $1,071.52 | $1,584.89 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $144.54 / $147.91
| Professional | | $144.54 | $144.54 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,290.87 / $7,244.36
| Facility | | $537.03 | $2,290.87 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $194.98 / $467.74
| Professional | | $93.33 | $194.98 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.49 / $117.49 / $363.08
| Facility | | $117.49 | $117.49 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $302.00 / $416.87
| Professional | | $125.89 | $302.00 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.13 / $85.11 / $162.18
| Facility | | $74.13 | $85.11 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $85.11 / $309.03
| Professional | | $51.29 | $85.11 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $1,202.26 / $3,890.45
| Facility | | $223.87 | $1,202.26 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $144.54 / $257.04
| Professional | | $85.11 | $144.54 | $257.04 |