- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $416.87 / $8,317.64
| Facility | | $218.78 | $416.87 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $218.78 / $489.78
| Professional | | $173.78 | $218.78 | $489.78 |
- 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 / $380.19 / $954.99
| Professional | | $190.55 | $380.19 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $616.60 / $1,000.00
| Facility | | $537.03 | $616.60 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $426.58 / $851.14
| Professional | | $199.53 | $426.58 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $263.03 / $4,365.16
| Facility | | $186.21 | $263.03 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $436.52 / $630.96
| Professional | | $354.81 | $436.52 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $269.15 / $7,943.28
| Facility | | $190.55 | $269.15 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $331.13 / $1,513.56
| Professional | | $186.21 | $331.13 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $70.79
| Professional | | $32.36 | $33.11 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $426.58 / $660.69
| Professional | | $239.88 | $426.58 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $7,943.28 / $7,943.28
| Facility | | $5,370.32 | $7,943.28 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $933.25 / $1,445.44
| Professional | | $204.17 | $933.25 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $724.44 / $724.44
| Professional | | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $724.44 / $1,023.29
| Professional | | $457.09 | $724.44 | $1,023.29 |
- 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
- $181.97 / $269.15 / $724.44
| Professional | | $181.97 | $269.15 | $724.44 |