- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,511.89 / $6,918.31
| Facility | | $537.03 | $2,511.89 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $245.47 / $446.68
| Professional | | $151.36 | $245.47 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $1,023.29 / $2,137.96
| Facility | | $602.56 | $1,023.29 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $269.15 / $436.52
| Professional | | $158.49 | $269.15 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $162.18 / $162.18
| Facility | | $79.43 | $162.18 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $295.12 / $501.19
| Professional | | $177.83 | $295.12 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $19,498.45 / $19,498.45
| Facility | | $3,981.07 | $19,498.45 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,570.40 / $2,570.40
| Professional | | $2,137.96 | $2,570.40 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $316.23 / $2,089.30
| Facility | | $162.18 | $316.23 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $281.84 / $575.44
| Professional | | $154.88 | $281.84 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $138.04 / $257.04
| Professional | | $32.36 | $138.04 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $295.12 / $562.34
| Professional | | $295.12 | $295.12 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $275.42 / $489.78
| Facility | | $158.49 | $275.42 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $302.00 / $501.19
| Professional | | $169.82 | $302.00 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,819.70 / $4,168.69
| Facility | | $436.52 | $1,819.70 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $223.87 / $371.54
| Professional | | $138.04 | $223.87 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $331.13 / $331.13
| Professional | | $316.23 | $331.13 | $331.13 |