- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.45 / $1,544.00 / $6,432.00
| Facility | | $229.45 | $1,544.00 | $6,432.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.50 / $218.53 / $423.26
| Professional | | $128.50 | $218.53 | $423.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,122.56 / $2,838.15 / $6,846.16
| Facility | | $2,122.56 | $2,838.15 | $6,846.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.26 / $256.58 / $302.50
| Professional | | $247.26 | $256.58 | $302.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.16 / $233.26 / $397.92
| Professional | | $154.16 | $233.26 | $397.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.00 / $296.97 / $393.38
| Professional | | $96.00 | $296.97 | $393.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,033.58 / $1,571.29 / $2,763.73
| Facility | | $1,033.58 | $1,571.29 | $2,763.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.60 / $243.02 / $271.63
| Professional | | $173.60 | $243.02 | $271.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $352.22 / $1,741.00 / $7,197.00
| Facility | | $352.22 | $1,741.00 | $7,197.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.03 / $232.75 / $447.21
| Professional | | $145.03 | $232.75 | $447.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.60 / $234.00 / $350.46
| Professional | | $158.60 | $234.00 | $350.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $284.45 / $284.45 / $284.45
| Facility | | $284.45 | $284.45 | $284.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.60 / $244.92 / $445.68
| Professional | | $158.60 | $244.92 | $445.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $155.00 / $163.94 / $244.88
| Facility | | $155.00 | $163.94 | $244.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.94 / $223.66 / $262.45
| Professional | | $159.94 | $223.66 | $262.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $412.00 / $1,155.00 / $3,742.00
| Facility | | $412.00 | $1,155.00 | $3,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.24 / $275.95 / $492.60
| Professional | | $213.24 | $275.95 | $492.60 |