- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $285.68 / $1,989.90 / $6,804.05
| Facility | | $285.68 | $1,989.90 | $6,804.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.90 / $270.85 / $554.78
| Professional | | $180.90 | $270.85 | $554.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.69 / $3,159.00 / $14,886.03
| Facility | | $2,344.69 | $3,159.00 | $14,886.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.08 / $333.49 / $505.61
| Professional | | $305.08 | $333.49 | $505.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.36 / $287.82 / $488.69
| Professional | | $185.36 | $287.82 | $488.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $10.00 / $366.56
| Professional | | $10.00 | $10.00 | $366.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,298.36 / $1,586.41 / $3,153.73
| Facility | | $1,298.36 | $1,586.41 | $3,153.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.84 / $303.41 / $342.47
| Professional | | $211.84 | $303.41 | $342.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $434.23 / $2,381.00 / $7,799.00
| Facility | | $434.23 | $2,381.00 | $7,799.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.93 / $285.68 / $611.35
| Professional | | $184.93 | $285.68 | $611.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.66 / $272.50 / $436.55
| Professional | | $199.66 | $272.50 | $436.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $358.71 / $358.71 / $358.71
| Facility | | $358.71 | $358.71 | $358.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.90 / $301.14 / $548.70
| Professional | | $197.90 | $301.14 | $548.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $191.85 / $206.63 / $301.48
| Facility | | $191.85 | $206.63 | $301.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.03 / $271.02 / $322.57
| Professional | | $201.03 | $271.02 | $322.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $412.00 / $1,219.00 / $4,300.00
| Facility | | $412.00 | $1,219.00 | $4,300.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.69 / $336.81 / $607.04
| Professional | | $260.69 | $336.81 | $607.04 |