- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $255.06 / $2,124.00 / $6,762.00
| Facility | | $255.06 | $2,124.00 | $6,762.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.88 / $180.19 / $271.24
| Professional | | $94.88 | $180.19 | $271.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,062.88 / $3,680.36 / $7,294.23
| Facility | | $2,062.88 | $3,680.36 | $7,294.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.71 / $194.66 / $319.77
| Professional | | $92.71 | $194.66 | $319.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.45 / $93.45 / $227.56
| Facility | | $93.45 | $93.45 | $227.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,322.00 / $1,818.57 / $2,361.01
| Facility | | $1,322.00 | $1,818.57 | $2,361.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $194.81 / $357.39
| Professional | | $109.65 | $194.81 | $357.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $568.40 / $11,500.00 / $12,000.00
| Facility | | $568.40 | $11,500.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $821.76 / $1,497.36 / $1,798.95
| Professional | | $821.76 | $1,497.36 | $1,798.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.04 / $194.17 / $326.67
| Facility | | $95.04 | $194.17 | $326.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.83 / $225.23 / $368.55
| Professional | | $127.83 | $225.23 | $368.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.03 / $223.96 / $487.58
| Professional | | $103.03 | $223.96 | $487.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.46 / $196.99 / $344.51
| Facility | | $95.46 | $196.99 | $344.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.09 / $221.59 / $440.32
| Professional | | $114.09 | $221.59 | $440.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,190.00 / $3,239.00 / $7,600.00
| Facility | | $1,190.00 | $3,239.00 | $7,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.88 / $215.44 / $331.21
| Professional | | $153.88 | $215.44 | $331.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.75 / $203.77 / $276.36
| Professional | | $174.75 | $203.77 | $276.36 |