- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $274.52 / $1,222.34 / $2,621.41
| Facility | | $274.52 | $1,222.34 | $2,621.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.24 / $296.54 / $2,076.63
| Professional | | $200.24 | $296.54 | $2,076.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.45 / $623.86 / $1,592.19
| Facility | | $281.45 | $623.86 | $1,592.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.49 / $292.61 / $514.15
| Professional | | $159.49 | $292.61 | $514.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58.90 / $100.00 / $3,322.70
| Facility | | $58.90 | $100.00 | $3,322.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.10 / $230.14 / $539.96
| Professional | | $161.10 | $230.14 | $539.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.68 / $454.69 / $1,114.43
| Facility | | $225.68 | $454.69 | $1,114.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.71 / $385.51 / $510.88
| Professional | | $214.71 | $385.51 | $510.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.27 / $322.95 / $355.26
| Professional | | $10.27 | $322.95 | $355.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.37 / $322.95 / $710.51
| Professional | | $258.37 | $322.95 | $710.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $516.74 / $1,534.06 / $1,534.06
| Facility | | $516.74 | $1,534.06 | $1,534.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.47 / $161.47 / $161.47
| Professional | | $161.47 | $161.47 | $161.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $171.17 / $322.95 / $801.89
| Facility | | $171.17 | $322.95 | $801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.99 / $324.60 / $510.88
| Professional | | $238.99 | $324.60 | $510.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,133.58 / $1,133.58 / $1,133.58
| Professional | | $1,133.58 | $1,133.58 | $1,133.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.48 / $17.46 / $290.66
| Professional | | $10.48 | $17.46 | $290.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.63 / $186.45 / $591.17
| Professional | | $135.63 | $186.45 | $591.17 |