- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $328.84 / $375.81 / $2,332.17
| Facility | | $328.84 | $375.81 | $2,332.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.80 / $328.84 / $2,005.10
| Professional | | $230.80 | $328.84 | $2,005.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.42 / $570.00 / $1,538.67
| Facility | | $34.42 | $570.00 | $1,538.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.71 / $338.69 / $799.19
| Professional | | $172.71 | $338.69 | $799.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.40 / $225.88 / $1,243.57
| Facility | | $59.40 | $225.88 | $1,243.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.89 / $432.61 / $884.85
| Professional | | $279.89 | $432.61 | $884.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $609.35 / $1,627.88 / $3,477.93
| Facility | | $609.35 | $1,627.88 | $3,477.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.01 / $388.86 / $1,014.58
| Professional | | $191.01 | $388.86 | $1,014.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.36 / $406.80 / $549.17
| Professional | | $149.36 | $406.80 | $549.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.35 / $397.45 / $689.00
| Professional | | $301.35 | $397.45 | $689.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $643.29 / $1,653.45 / $1,653.45
| Facility | | $643.29 | $1,653.45 | $1,653.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,065.29 / $2,065.29 / $2,557.35
| Professional | | $2,065.29 | $2,065.29 | $2,557.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $200.00 / $417.82 / $2,561.08
| Facility | | $200.00 | $417.82 | $2,561.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.13 / $377.57 / $1,014.27
| Professional | | $189.13 | $377.57 | $1,014.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,153.77 / $1,153.77 / $1,153.77
| Professional | | $1,153.77 | $1,153.77 | $1,153.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.04 / $329.04 / $452.43
| Professional | | $224.04 | $329.04 | $452.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $514.13 / $876.66 / $1,260.00
| Facility | | $514.13 | $876.66 | $1,260.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.12 / $348.63 / $1,048.17
| Professional | | $209.12 | $348.63 | $1,048.17 |