- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $3,548.13 / $8,128.31
| Facility | | $194.98 | $3,548.13 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $151.36 / $457.09
| Professional | | $112.20 | $151.36 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $4,786.30 / $10,232.93
| Facility | | $2,630.27 | $4,786.30 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $131.83 / $346.74
| Professional | | $104.71 | $131.83 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $1,698.24 / $6,165.95
| Facility | | $186.21 | $1,698.24 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $186.21 / $186.21
| Professional | | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $1,659.59 / $50,118.72
| Facility | | $223.87 | $1,659.59 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $245.47 / $588.84
| Professional | | $134.90 | $245.47 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $131.83 / $309.03
| Facility | | $34.67 | $131.83 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $165.96 / $234.42
| Professional | | $123.03 | $165.96 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $169.82 / $323.59
| Professional | | $112.20 | $169.82 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $4,073.80 / $4,073.80
| Facility | | $4,073.80 | $4,073.80 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $50,118.72 / $75,857.76
| Facility | | $141.25 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $204.17 / $398.11
| Professional | | $162.18 | $204.17 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $4,365.16 / $9,549.93
| Facility | | $2,137.96 | $4,365.16 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $177.83 / $354.81
| Professional | | $125.89 | $177.83 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $147.91 / $467.74
| Facility | | $104.71 | $147.91 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $158.49 / $407.38
| Professional | | $104.71 | $158.49 | $407.38 |