- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $793.13 / $2,015.71 / $6,011.93
| Facility | | $793.13 | $2,015.71 | $6,011.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.43 / $746.56 / $999.50
| Professional | | $175.43 | $746.56 | $999.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,456.92 / $5,821.21 / $8,577.84
| Facility | | $5,456.92 | $5,821.21 | $8,577.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.34 / $14.34 / $47.78
| Professional | | $14.34 | $14.34 | $47.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $80.00 / $80.00
| Facility | | $80.00 | $80.00 | $80.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $231.15 / $231.15 / $231.15
| Facility | | $231.15 | $231.15 | $231.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.44 / $130.63 / $244.95
| Professional | | $123.44 | $130.63 | $244.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $336.44 / $995.80 / $995.80
| Facility | | $336.44 | $995.80 | $995.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,657.26 / $3,657.26 / $3,657.26
| Professional | | $3,657.26 | $3,657.26 | $3,657.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.06 / $591.01 / $1,232.80
| Facility | | $157.06 | $591.01 | $1,232.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.25 / $154.25 / $154.30
| Professional | | $154.25 | $154.25 | $154.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $163.03 / $632.79 / $1,542.22
| Facility | | $163.03 | $632.79 | $1,542.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.44 / $130.63 / $270.02
| Professional | | $123.44 | $130.63 | $270.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $753.55 / $1,103.66 / $1,642.57
| Professional | | $753.55 | $1,103.66 | $1,642.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.25 / $219.78 / $533.80
| Professional | | $154.25 | $219.78 | $533.80 |