- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $2,089.30 / $3,801.89
| Facility | | $151.36 | $2,089.30 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $151.36 / $436.52
| Professional | | $102.33 | $151.36 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $645.65 / $2,754.23
| Facility | | $56.23 | $645.65 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $213.80 / $501.19
| Professional | | $120.23 | $213.80 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $128.82 / $295.12
| Facility | | $128.82 | $128.82 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $354.81 / $537.03
| Professional | | $223.87 | $354.81 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $245.47 / $524.81
| Professional | | $144.54 | $245.47 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $213.80 / $7,079.46
| Facility | | $100.00 | $213.80 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $190.55 / $295.12
| Professional | | $104.71 | $190.55 | $295.12 |
- 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
- $123.03 / $213.80 / $446.68
| Professional | | $123.03 | $213.80 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $426.58 / $467.74
| Facility | | $162.18 | $426.58 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $295.12 / $295.12
| Professional | | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $645.65 / $2,754.23
| Facility | | $56.23 | $645.65 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $208.93 / $489.78
| Professional | | $120.23 | $208.93 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,819.70 / $2,818.38
| Facility | | $501.19 | $1,819.70 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $223.87 / $457.09
| Professional | | $138.04 | $223.87 | $457.09 |