- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.93 / $4,778.89 / $13,841.56
| Facility | | $270.93 | $4,778.89 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.86 / $377.18 / $1,902.02
| Professional | | $159.86 | $377.18 | $1,902.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.62 / $593.21 / $628.64
| Professional | | $163.62 | $593.21 | $628.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,712.35 / $6,198.03 / $11,988.99
| Facility | | $4,712.35 | $6,198.03 | $11,988.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.38 / $327.20 / $552.00
| Professional | | $169.38 | $327.20 | $552.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,368.73 / $2,368.73 / $2,368.73
| Facility | | $2,368.73 | $2,368.73 | $2,368.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.78 / $566.45 / $915.12
| Professional | | $335.78 | $566.45 | $915.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.83 / $447.03 / $1,174.50
| Facility | | $199.83 | $447.03 | $1,174.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $629.54 / $919.00 / $1,792.20
| Professional | | $629.54 | $919.00 | $1,792.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $458.34 / $856.76 / $2,842.49
| Facility | | $458.34 | $856.76 | $2,842.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $429.99 / $786.37 / $1,106.80
| Professional | | $429.99 | $786.37 | $1,106.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.12 / $317.55 / $580.50
| Professional | | $182.12 | $317.55 | $580.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $6,451.00 / $7,934.00
| Facility | | $4,217.00 | $6,451.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $651.32 / $991.07 / $1,423.07
| Professional | | $651.32 | $991.07 | $1,423.07 |