- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $331.13 / $3,090.30
| Facility | | $141.25 | $331.13 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $245.47 / $549.54
| Professional | | $114.82 | $245.47 | $549.54 |
- 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
- $190.55 / $416.87 / $1,023.29
| Professional | | $190.55 | $416.87 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $851.14 / $1,348.96
| Facility | | $724.44 | $851.14 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $426.58 / $977.24
| Professional | | $194.98 | $426.58 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $512.86 / $4,168.69
| Facility | | $141.25 | $512.86 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $389.05 / $794.33
| Professional | | $257.04 | $389.05 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $549.54 / $5,623.41
| Facility | | $141.25 | $549.54 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $457.09 / $1,995.26
| Professional | | $257.04 | $457.09 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $302.00
| Professional | | $32.36 | $33.11 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $380.19 / $933.25
| Professional | | $204.17 | $380.19 | $933.25 |
- 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
- $162.18 / $588.84 / $1,905.46
| Professional | | $162.18 | $588.84 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $707.95 / $1,621.81
| Professional | | $295.12 | $707.95 | $1,621.81 |
- 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
- $138.04 / $331.13 / $954.99
| Professional | | $138.04 | $331.13 | $954.99 |