- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $2,818.38 / $5,623.41
| Facility | | $128.82 | $2,818.38 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $295.12 / $660.69
| Professional | | $147.91 | $295.12 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $851.14 / $3,548.13
| Facility | | $56.23 | $851.14 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $346.74 / $2,238.72
| Professional | | $162.18 | $346.74 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $223.87 / $512.86
| Facility | | $223.87 | $223.87 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $549.54 / $549.54
| Professional | | $97.72 | $549.54 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $537.03 / $741.31
| Facility | | $100.00 | $537.03 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $338.84 / $724.44
| Professional | | $158.49 | $338.84 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $316.23 / $7,079.46
| Facility | | $177.83 | $316.23 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $524.81 / $758.58
| Professional | | $371.54 | $524.81 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $1,949.84 / $7,079.46
| Facility | | $346.74 | $1,949.84 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $436.52 / $912.01
| Professional | | $234.42 | $436.52 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $239.88 / $239.88
| Professional | | $239.88 | $239.88 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $851.14 / $3,548.13
| Facility | | $56.23 | $851.14 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $346.74 / $2,238.72
| Professional | | $162.18 | $346.74 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $2,041.74 / $5,623.41
| Facility | | $467.74 | $2,041.74 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $338.84 / $851.14
| Professional | | $158.49 | $338.84 | $851.14 |