- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $369.41 / $2,485.00 / $7,316.00
| Facility | | $369.41 | $2,485.00 | $7,316.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.43 / $253.59 / $390.60
| Professional | | $153.43 | $253.59 | $390.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,875.46 / $3,981.32 / $8,067.41
| Facility | | $1,875.46 | $3,981.32 | $8,067.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.18 / $257.01 / $435.54
| Professional | | $149.18 | $257.01 | $435.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.43 / $3,440.65 / $3,440.65
| Facility | | $147.43 | $3,440.65 | $3,440.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,508.82 / $1,924.45 / $2,355.06
| Facility | | $1,508.82 | $1,924.45 | $2,355.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.43 / $283.93 / $488.03
| Professional | | $171.43 | $283.93 | $488.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,135.56 / $11,500.00 / $16,394.00
| Facility | | $1,135.56 | $11,500.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,259.00 / $2,202.16 / $2,589.30
| Professional | | $1,259.00 | $2,202.16 | $2,589.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.91 / $272.58 / $448.32
| Facility | | $157.91 | $272.58 | $448.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.42 / $327.35 / $535.66
| Professional | | $209.42 | $327.35 | $535.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $265.60 / $852.30
| Professional | | $5.00 | $265.60 | $852.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.69 / $277.79 / $497.28
| Facility | | $158.69 | $277.79 | $497.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.00 / $317.35 / $594.25
| Professional | | $177.00 | $317.35 | $594.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $593.00 / $2,045.00 / $4,480.00
| Facility | | $593.00 | $2,045.00 | $4,480.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.62 / $290.16 / $458.45
| Professional | | $217.62 | $290.16 | $458.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.98 / $296.95 / $403.49
| Professional | | $253.98 | $296.95 | $403.49 |