- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $205.18 / $1,192.48 / $2,127.50
| Facility | | $205.18 | $1,192.48 | $2,127.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.23 / $221.91 / $647.47
| Professional | | $117.23 | $221.91 | $647.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $259.95 / $1,117.67 / $3,804.00
| Facility | | $259.95 | $1,117.67 | $3,804.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.88 / $286.43 / $904.29
| Professional | | $114.88 | $286.43 | $904.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.34 / $889.26 / $1,203.54
| Facility | | $158.34 | $889.26 | $1,203.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.41 / $1,367.15 / $2,047.94
| Facility | | $606.41 | $1,367.15 | $2,047.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.25 / $309.02 / $479.86
| Professional | | $208.25 | $309.02 | $479.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.07 / $300.00 / $6,679.00
| Facility | | $108.07 | $300.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.69 / $188.54 / $325.83
| Professional | | $97.69 | $188.54 | $325.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.47 / $286.63 / $467.24
| Professional | | $131.47 | $286.63 | $467.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.69 / $1,065.48 / $1,938.55
| Facility | | $715.69 | $1,065.48 | $1,938.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.71 / $224.16 / $259.57
| Professional | | $163.71 | $224.16 | $259.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.90 / $2,078.00 / $7,161.00
| Facility | | $612.90 | $2,078.00 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.28 / $454.75 / $1,785.61
| Professional | | $218.28 | $454.75 | $1,785.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $96.08 / $851.19 / $1,254.27
| Facility | | $96.08 | $851.19 | $1,254.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.00 / $2,408.00 / $5,683.00
| Facility | | $1,106.00 | $2,408.00 | $5,683.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.11 / $380.21 / $680.14
| Professional | | $201.11 | $380.21 | $680.14 |