- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $243.26 / $2,124.00 / $6,762.00
| Facility | | $243.26 | $2,124.00 | $6,762.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.61 / $165.72 / $253.26
| Professional | | $79.61 | $165.72 | $253.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,806.19 / $3,539.71 / $7,126.31
| Facility | | $1,806.19 | $3,539.71 | $7,126.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.40 / $179.51 / $302.56
| Professional | | $78.40 | $179.51 | $302.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.36 / $79.36 / $218.25
| Facility | | $79.36 | $79.36 | $218.25 |
- 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
- $92.38 / $186.19 / $351.89
| Professional | | $92.38 | $186.19 | $351.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.30 / $11,500.00 / $12,000.00
| Facility | | $478.30 | $11,500.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $780.81 / $1,431.28 / $1,719.90
| Professional | | $780.81 | $1,431.28 | $1,719.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.81 / $160.07 / $312.01
| Facility | | $79.81 | $160.07 | $312.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.65 / $215.27 / $352.26
| Professional | | $107.65 | $215.27 | $352.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.27 / $211.38 / $466.78
| Professional | | $87.27 | $211.38 | $466.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.44 / $167.00 / $321.99
| Facility | | $80.44 | $167.00 | $321.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.78 / $211.30 / $422.58
| Professional | | $96.78 | $211.30 | $422.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $655.00 / $2,311.00 / $4,764.00
| Facility | | $655.00 | $2,311.00 | $4,764.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.38 / $205.02 / $318.22
| Professional | | $150.38 | $205.02 | $318.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.02 / $194.80 / $264.33
| Professional | | $167.02 | $194.80 | $264.33 |