- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $451.20 / $2,124.00 / $6,762.00
| Facility | | $451.20 | $2,124.00 | $6,762.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.30 / $343.69 / $534.20
| Professional | | $154.30 | $343.69 | $534.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,207.68 / $2,367.25 / $4,734.50
| Facility | | $1,207.68 | $2,367.25 | $4,734.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.80 / $378.49 / $604.41
| Professional | | $144.80 | $378.49 | $604.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $139.91 / $139.91 / $450.51
| Facility | | $139.91 | $139.91 | $450.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $935.02 / $1,240.44 / $1,652.00
| Facility | | $935.02 | $1,240.44 | $1,652.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.36 / $354.94 / $666.60
| Professional | | $182.36 | $354.94 | $666.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,082.16 / $11,500.00 / $12,000.00
| Facility | | $1,082.16 | $11,500.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,929.00 / $2,962.24 / $3,462.45
| Professional | | $1,929.00 | $2,962.24 | $3,462.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $159.88 / $384.97 / $651.61
| Facility | | $159.88 | $384.97 | $651.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.75 / $439.08 / $718.49
| Professional | | $199.75 | $439.08 | $718.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $307.30 / $1,171.40
| Professional | | $5.00 | $307.30 | $1,171.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.50 / $397.90 / $694.82
| Facility | | $160.50 | $397.90 | $694.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.07 / $403.91 / $840.50
| Professional | | $187.07 | $403.91 | $840.50 |
- 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
- $330.00 / $442.02 / $682.07
| Professional | | $330.00 | $442.02 | $682.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.67 / $398.48 / $541.19
| Professional | | $340.67 | $398.48 | $541.19 |