- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $2,089.30 / $5,128.61
| Facility | | $141.25 | $2,089.30 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $147.91 / $426.58
| Professional | | $85.11 | $147.91 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $2,344.23 / $19,498.45
| Facility | | $213.80 | $2,344.23 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $194.98 / $1,819.70
| Professional | | $93.33 | $194.98 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $234.42
| Facility | | $100.00 | $100.00 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $309.03 / $616.60
| Professional | | $147.91 | $309.03 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $501.19 / $1,412.54
| Facility | | $446.68 | $501.19 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $208.93 / $524.81
| Professional | | $104.71 | $208.93 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $380.19 / $7,079.46
| Facility | | $83.18 | $380.19 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $407.38 / $602.56
| Professional | | $263.03 | $407.38 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $3,162.28 / $8,511.38
| Facility | | $616.60 | $3,162.28 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $251.19 / $724.44
| Professional | | $97.72 | $251.19 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $1,949.84 / $3,388.44
| Facility | | $165.96 | $1,949.84 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $2,344.23 / $19,498.45
| Facility | | $213.80 | $2,344.23 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $190.55 / $1,819.70
| Professional | | $93.33 | $190.55 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $3,019.95 / $8,511.38
| Facility | | $676.08 | $3,019.95 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $177.83 / $630.96
| Professional | | $93.33 | $177.83 | $630.96 |