- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.89 / $208.93 / $1,905.46
| Facility | | $125.89 | $208.93 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $158.49 / $380.19
| Professional | | $100.00 | $158.49 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,090.30 / $5,754.40
| Facility | | $1,584.89 | $3,090.30 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $288.40 / $758.58
| Professional | | $151.36 | $288.40 | $758.58 |
- 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
- $181.97 / $338.84 / $549.54
| Professional | | $181.97 | $338.84 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $309.03 / $3,801.89
| Facility | | $128.82 | $309.03 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $309.03 / $446.68
| Professional | | $239.88 | $309.03 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.89 / $1,584.89 / $4,168.69
| Facility | | $125.89 | $1,584.89 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $346.74 / $870.96
| Professional | | $194.98 | $346.74 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $50.12 / $316.23
| Professional | | $32.36 | $50.12 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $323.59 / $524.81
| Professional | | $186.21 | $323.59 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,905.46 / $1,905.46
| Facility | | $1,288.25 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $741.31 / $1,122.02
| Professional | | $181.97 | $741.31 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $724.44 / $1,047.13
| Professional | | $537.03 | $724.44 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,818.38 / $4,677.35
| Facility | | $2,187.76 | $2,818.38 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $302.00 / $630.96
| Professional | | $134.90 | $302.00 | $630.96 |