- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $630.96 / $7,413.10
| Facility | | $263.03 | $630.96 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $537.03 / $1,047.13
| Professional | | $257.04 | $537.03 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $7,943.28 / $13,182.57
| Facility | | $5,011.87 | $7,943.28 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $891.25 / $2,344.23
| Professional | | $416.87 | $891.25 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,905.46 / $3,019.95
| Facility | | $1,621.81 | $1,905.46 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $933.25 / $2,187.76
| Professional | | $426.58 | $933.25 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $891.25 / $4,168.69
| Facility | | $309.03 | $891.25 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $870.96 / $1,621.81
| Professional | | $549.54 | $870.96 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $1,148.15 / $8,317.64
| Facility | | $309.03 | $1,148.15 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $1,288.25 / $9,120.11
| Professional | | $602.56 | $1,288.25 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $776.25
| Professional | | $32.36 | $33.11 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $851.14 / $1,995.26
| Professional | | $446.68 | $851.14 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $9,332.54 / $9,332.54
| Facility | | $6,309.57 | $9,332.54 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $1,202.26 / $9,332.54
| Professional | | $354.81 | $1,202.26 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,995.26 / $3,630.78
| Professional | | $1,174.90 | $1,995.26 | $3,630.78 |
- 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
- $309.03 / $776.25 / $2,137.96
| Professional | | $309.03 | $776.25 | $2,137.96 |