- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $3,630.78 / $8,317.64
| Facility | | $316.23 | $3,630.78 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $323.59 / $831.76
| Professional | | $151.36 | $323.59 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $281.84 / $446.68
| Professional | | $131.83 | $281.84 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,248.07 / $57,543.99
| Facility | | $5,011.87 | $5,248.07 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $537.03 / $630.96
| Professional | | $229.09 | $537.03 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $275.42 / $512.86
| Professional | | $154.88 | $275.42 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $257.04 / $512.86
| Professional | | $95.50 | $257.04 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $354.81 / $501.19
| Professional | | $162.18 | $354.81 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,168.69 / $7,413.10
| Facility | | $2,238.72 | $4,168.69 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $3,235.94 / $8,128.31
| Facility | | $302.00 | $3,235.94 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $323.59 / $794.33
| Professional | | $154.88 | $323.59 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $3,090.30 / $6,606.93
| Facility | | $588.84 | $3,090.30 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $549.54 / $691.83
| Professional | | $363.08 | $549.54 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $295.12 / $407.38
| Facility | | $128.82 | $295.12 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $302.00 / $407.38
| Professional | | $128.82 | $302.00 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $2,754.23 / $6,606.93
| Facility | | $912.01 | $2,754.23 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $263.03 / $457.09
| Professional | | $154.88 | $263.03 | $457.09 |