- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,691.53 / $8,317.64
| Facility | | $537.03 | $2,691.53 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $213.80 / $398.11
| Professional | | $95.50 | $213.80 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $2,691.53 / $57,543.99
| Facility | | $2,630.27 | $2,691.53 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $288.40 / $446.68
| Professional | | $257.04 | $288.40 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $181.97 / $181.97
| Facility | | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $208.93 / $426.58
| Professional | | $104.71 | $208.93 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $457.09 / $562.34
| Professional | | $331.13 | $457.09 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $316.23 / $446.68
| Professional | | $186.21 | $316.23 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $676.08 / $676.08
| Facility | | $676.08 | $676.08 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $2,290.87 / $7,762.47
| Facility | | $588.84 | $2,290.87 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $245.47 / $645.65
| Professional | | $100.00 | $245.47 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $263.03 / $562.34
| Facility | | $263.03 | $263.03 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $257.04 / $575.44
| Professional | | $251.19 | $257.04 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $239.88 / $446.68
| Facility | | $102.33 | $239.88 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $257.04 / $446.68
| Professional | | $102.33 | $257.04 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,862.09 / $3,890.45
| Facility | | $501.19 | $1,862.09 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $204.17 / $389.05
| Professional | | $100.00 | $204.17 | $389.05 |