- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $2,290.87 / $7,244.36
| Facility | | $147.91 | $2,290.87 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $144.54 / $380.19
| Professional | | $91.20 | $144.54 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $141.25 / $165.96
| Professional | | $45.71 | $141.25 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $8,511.38 / $77,624.71
| Facility | | $5,011.87 | $8,511.38 | $77,624.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $177.83 / $257.04
| Professional | | $128.82 | $177.83 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $158.49 / $269.15
| Professional | | $109.65 | $158.49 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $234.42 / $257.04
| Professional | | $181.97 | $234.42 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $190.55 / $269.15
| Professional | | $120.23 | $190.55 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $831.76 / $5,128.61
| Facility | | $676.08 | $831.76 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $1,995.26 / $6,165.95
| Facility | | $218.78 | $1,995.26 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $158.49 / $389.05
| Professional | | $97.72 | $158.49 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $204.17 / $316.23
| Facility | | $204.17 | $204.17 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $239.88 / $302.00
| Professional | | $173.78 | $239.88 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.72 / $147.91 / $257.04
| Facility | | $97.72 | $147.91 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $147.91 / $309.03
| Professional | | $77.62 | $147.91 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $2,570.40 / $5,011.87
| Facility | | $912.01 | $2,570.40 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $144.54 / $245.47
| Professional | | $100.00 | $144.54 | $245.47 |