- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $1,905.46 / $3,715.35
| Facility | | $154.88 | $1,905.46 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.15 / $128.82 / $512.86
| Professional | | $37.15 | $128.82 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $954.99 / $2,818.38
| Facility | | $56.23 | $954.99 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $147.91 / $977.24
| Professional | | $39.81 | $147.91 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.69 / $41.69 / $97.72
| Facility | | $41.69 | $41.69 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $208.93 / $489.78
| Professional | | $41.69 | $208.93 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $109.65 / $446.68
| Professional | | $45.71 | $109.65 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.90 / $83.18 / $8,511.38
| Facility | | $38.90 | $83.18 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $269.15 / $407.38
| Professional | | $204.17 | $269.15 | $407.38 |
- 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
- $38.90 / $138.04 / $436.52
| Professional | | $38.90 | $138.04 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.61 / $407.38 / $588.84
| Facility | | $67.61 | $407.38 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $57.54 / $144.54
| Professional | | $40.74 | $57.54 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,000.00 / $2,818.38
| Facility | | $56.23 | $1,000.00 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $147.91 / $977.24
| Professional | | $39.81 | $147.91 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,862.09 / $2,818.38
| Facility | | $501.19 | $1,862.09 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $134.90 / $416.87
| Professional | | $41.69 | $134.90 | $416.87 |