- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.92 / $1,828.32 / $6,551.16
| Facility | | $207.92 | $1,828.32 | $6,551.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.47 / $198.02 / $375.47
| Professional | | $134.47 | $198.02 | $375.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.23 / $106.23 / $106.23
| Professional | | $106.23 | $106.23 | $106.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.69 / $3,159.00 / $14,886.03
| Facility | | $2,344.69 | $3,159.00 | $14,886.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.51 / $232.98 / $382.39
| Professional | | $224.51 | $232.98 | $382.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.83 / $222.39 / $403.32
| Professional | | $159.83 | $222.39 | $403.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.92 / $347.04 / $358.02
| Professional | | $269.92 | $347.04 | $358.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,070.35 / $3,505.43 / $7,262.42
| Facility | | $1,070.35 | $3,505.43 | $7,262.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.12 / $219.13 / $288.67
| Professional | | $180.12 | $219.13 | $288.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $255.06 / $1,913.35 / $7,197.00
| Facility | | $255.06 | $1,913.35 | $7,197.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.68 / $213.72 / $450.87
| Professional | | $153.68 | $213.72 | $450.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.92 / $248.50 / $323.11
| Professional | | $168.92 | $248.50 | $323.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.31 / $302.31 / $302.31
| Facility | | $302.31 | $302.31 | $302.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.28 / $228.33 / $413.51
| Professional | | $166.28 | $228.33 | $413.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $161.63 / $173.55 / $221.60
| Facility | | $161.63 | $173.55 | $221.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.32 / $215.13 / $237.07
| Professional | | $169.32 | $215.13 | $237.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $412.00 / $1,219.00 / $4,300.00
| Facility | | $412.00 | $1,219.00 | $4,300.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.01 / $241.60 / $403.84
| Professional | | $189.01 | $241.60 | $403.84 |