- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $2,187.76 / $3,715.35
| Facility | | $186.21 | $2,187.76 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $208.93 / $537.03
| Professional | | $109.65 | $208.93 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,258.93 / $4,677.35
| Facility | | $56.23 | $1,258.93 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $234.42 / $1,513.56
| Professional | | $117.49 | $234.42 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $134.90 / $316.23
| Facility | | $134.90 | $134.90 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $257.04 / $478.63
| Professional | | $190.55 | $257.04 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $275.42 / $501.19
| Facility | | $100.00 | $275.42 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $251.19 / $512.86
| Professional | | $131.83 | $251.19 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $218.78 / $7,079.46
| Facility | | $109.65 | $218.78 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $346.74 / $478.63
| Professional | | $251.19 | $346.74 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $3,162.28 / $8,511.38
| Facility | | $616.60 | $3,162.28 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $281.84 / $588.84
| Professional | | $131.83 | $281.84 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,238.72 / $8,912.51
| Facility | | $1,949.84 | $2,238.72 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $380.19 / $380.19
| Professional | | $380.19 | $380.19 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,258.93 / $4,677.35
| Facility | | $56.23 | $1,258.93 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $234.42 / $1,513.56
| Professional | | $117.49 | $234.42 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $3,019.95 / $8,511.38
| Facility | | $676.08 | $3,019.95 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $229.09 / $549.54
| Professional | | $117.49 | $229.09 | $549.54 |