- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $262.05 / $2,124.00 / $6,762.00
| Facility | | $262.05 | $2,124.00 | $6,762.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.16 / $212.63 / $295.25
| Professional | | $144.16 | $212.63 | $295.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,038.99 / $2,091.48 / $4,021.03
| Facility | | $1,038.99 | $2,091.48 | $4,021.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.68 / $180.00 / $282.86
| Professional | | $123.68 | $180.00 | $282.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.01 / $292.29 / $292.29
| Professional | | $244.01 | $292.29 | $292.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $135.44 / $135.44 / $135.44
| Facility | | $135.44 | $135.44 | $135.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $943.63 / $943.63 / $943.63
| Facility | | $943.63 | $943.63 | $943.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.27 / $242.89 / $410.57
| Professional | | $156.27 | $242.89 | $410.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,029.83 / $12,000.00 / $12,000.00
| Facility | | $1,029.83 | $12,000.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,080.96 / $1,562.88 / $1,838.25
| Professional | | $1,080.96 | $1,562.88 | $1,838.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $142.83 / $221.78 / $425.44
| Facility | | $142.83 | $221.78 | $425.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.64 / $271.33 / $380.20
| Professional | | $189.64 | $271.33 | $380.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.90 / $170.90 / $170.90
| Professional | | $170.90 | $170.90 | $170.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $142.83 / $223.81 / $451.67
| Facility | | $142.83 | $223.81 | $451.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.76 / $250.16 / $425.55
| Professional | | $159.76 | $250.16 | $425.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $564.00 / $2,064.00 / $4,509.00
| Facility | | $564.00 | $2,064.00 | $4,509.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.42 / $246.67 / $379.15
| Professional | | $178.42 | $246.67 | $379.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.27 / $201.58 / $286.44
| Professional | | $180.27 | $201.58 | $286.44 |