- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $2,570.40 / $2,691.53
| Facility | | $186.21 | $2,570.40 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $186.21 / $537.03
| Professional | | $144.54 | $186.21 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,786.30 / $7,585.78
| Facility | | $3,311.31 | $4,786.30 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $302.00 / $741.31
| Professional | | $151.36 | $302.00 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $467.74 / $741.31
| Facility | | $398.11 | $467.74 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $489.78 / $549.54
| Professional | | $223.87 | $489.78 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $2,884.03 / $5,370.32
| Facility | | $186.21 | $2,884.03 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $389.05 / $478.63
| Professional | | $275.42 | $389.05 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $3,235.94 / $6,165.95
| Facility | | $181.97 | $3,235.94 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $288.40 / $1,778.28
| Professional | | $154.88 | $288.40 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $213.80
| Professional | | $32.36 | $33.11 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $338.84 / $588.84
| Professional | | $177.83 | $338.84 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $4,466.84 / $4,466.84
| Facility | | $3,019.95 | $4,466.84 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $741.31 / $1,778.28
| Professional | | $213.80 | $741.31 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $831.76 / $933.25
| Professional | | $389.05 | $831.76 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,801.89 / $6,456.54
| Facility | | $2,884.03 | $3,801.89 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $251.19 / $660.69
| Professional | | $147.91 | $251.19 | $660.69 |