- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $289.74 / $3,224.12 / $7,773.10
| Facility | | $289.74 | $3,224.12 | $7,773.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.56 / $273.87 / $498.00
| Professional | | $195.56 | $273.87 | $498.00 |
- 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
- $310.16 / $321.86 / $321.86
| Professional | | $310.16 | $321.86 | $321.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.91 / $305.61 / $534.02
| Professional | | $206.91 | $305.61 | $534.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.08 / $478.39 / $493.49
| Professional | | $372.08 | $478.39 | $493.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,338.50 / $3,449.09 / $8,186.60
| Facility | | $1,338.50 | $3,449.09 | $8,186.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.26 / $301.94 / $347.24
| Professional | | $216.26 | $301.94 | $347.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $657.00 / $3,654.00 / $8,017.00
| Facility | | $657.00 | $3,654.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.28 / $290.08 / $607.15
| Professional | | $197.28 | $290.08 | $607.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.74 / $312.30 / $443.54
| Professional | | $213.74 | $312.30 | $443.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $384.14 / $384.14 / $384.14
| Facility | | $384.14 | $384.14 | $384.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.14 / $308.33 / $575.21
| Professional | | $209.14 | $308.33 | $575.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.50 / $220.46 / $305.82
| Facility | | $218.50 | $220.46 | $305.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.50 / $271.25 / $326.60
| Professional | | $218.50 | $271.25 | $326.60 |
- 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
- $267.33 / $343.32 / $615.46
| Professional | | $267.33 | $343.32 | $615.46 |