- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $549.54 / $6,456.54
| Facility | | $295.12 | $549.54 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $407.38 / $776.25
| Professional | | $251.19 | $407.38 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $4,570.88 / $7,079.46
| Facility | | $2,630.27 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $645.65 / $1,698.24
| Professional | | $331.13 | $645.65 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,380.38 / $2,187.76
| Facility | | $1,174.90 | $1,380.38 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $676.08 / $1,659.59
| Professional | | $302.00 | $676.08 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $426.58 / $3,630.78
| Facility | | $257.04 | $426.58 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $776.25 / $1,202.26
| Professional | | $489.78 | $776.25 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $436.52 / $5,495.41
| Facility | | $263.03 | $436.52 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $912.01 / $3,235.94
| Professional | | $389.05 | $912.01 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $346.74
| Professional | | $32.36 | $33.11 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $794.33 / $1,412.54
| Professional | | $426.58 | $794.33 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,995.26 / $1,995.26
| Facility | | $1,122.02 | $1,995.26 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $891.25 / $3,090.30
| Professional | | $295.12 | $891.25 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,348.96 / $2,187.76
| Professional | | $812.83 | $1,348.96 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $7,413.10 / $9,120.11
| Facility | | $4,897.79 | $7,413.10 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $446.68 / $1,202.26
| Professional | | $269.15 | $446.68 | $1,202.26 |