- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.10 / $181.97 / $14,454.40
| Facility | | $87.10 | $181.97 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $125.89 / $234.42
| Professional | | $87.10 | $125.89 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,090.30 / $5,754.40
| Facility | | $1,584.89 | $3,090.30 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $331.13 / $776.25
| Professional | | $181.97 | $331.13 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $616.60 / $1,000.00
| Facility | | $537.03 | $616.60 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $181.97 / $371.54
| Professional | | $141.25 | $181.97 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $363.08 / $3,801.89
| Facility | | $107.15 | $363.08 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $269.15 / $467.74
| Professional | | $173.78 | $269.15 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $912.01 / $1,778.28
| Facility | | $107.15 | $912.01 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $426.58 / $1,071.52
| Professional | | $251.19 | $426.58 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $64.57
| Professional | | $32.36 | $33.11 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $281.84 / $562.34
| Professional | | $165.96 | $281.84 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $323.59 / $602.56
| Facility | | $323.59 | $323.59 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $549.54 / $1,288.25
| Professional | | $154.88 | $549.54 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $181.97 / $380.19
| Professional | | $181.97 | $181.97 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $416.87 / $851.14
| Professional | | $151.36 | $416.87 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,584.89 / $1,949.84
| Facility | | $1,023.29 | $1,584.89 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $302.00 / $891.25
| Professional | | $120.23 | $302.00 | $891.25 |