- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $389.05 / $3,090.30
| Facility | | $162.18 | $389.05 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $346.74 / $691.83
| Professional | | $158.49 | $346.74 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $4,570.88 / $7,079.46
| Facility | | $2,344.23 | $4,570.88 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $602.56 / $1,479.11
| Professional | | $257.04 | $602.56 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,174.90 / $1,862.09
| Facility | | $1,000.00 | $1,174.90 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $575.44 / $1,348.96
| Professional | | $257.04 | $575.44 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $524.81 / $4,168.69
| Facility | | $162.18 | $524.81 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $537.03 / $1,023.29
| Professional | | $338.84 | $537.03 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $691.83 / $4,466.84
| Facility | | $151.36 | $691.83 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $741.31 / $3,388.44
| Professional | | $389.05 | $741.31 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $478.63
| Professional | | $32.36 | $33.11 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $524.81 / $1,202.26
| Professional | | $281.84 | $524.81 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,951.21 / $2,951.21
| Facility | | $891.25 | $2,951.21 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $758.58 / $3,467.37
| Professional | | $218.78 | $758.58 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,737.80 / $2,238.72
| Professional | | $933.25 | $1,737.80 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,884.03 / $5,011.87
| Facility | | $2,344.23 | $2,884.03 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $501.19 / $1,412.54
| Professional | | $186.21 | $501.19 | $1,412.54 |