- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $387.56 / $2,124.00 / $6,762.00
| Facility | | $387.56 | $2,124.00 | $6,762.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.95 / $226.90 / $416.68
| Professional | | $89.95 | $226.90 | $416.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,015.99 / $3,680.36 / $7,294.23
| Facility | | $2,015.99 | $3,680.36 | $7,294.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.25 / $258.39 / $431.11
| Professional | | $87.25 | $258.39 | $431.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $88.23 / $88.23 / $351.67
| Facility | | $88.23 | $88.23 | $351.67 |
- 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
- $106.31 / $224.49 / $500.22
| Professional | | $106.31 | $224.49 | $500.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $539.79 / $11,500.00 / $12,000.00
| Facility | | $539.79 | $11,500.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.77 / $2,293.28 / $2,744.93
| Professional | | $1,230.77 | $2,293.28 | $2,744.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.41 / $265.31 / $479.07
| Facility | | $95.41 | $265.31 | $479.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.52 / $344.07 / $563.02
| Professional | | $121.52 | $344.07 | $563.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.65 / $319.38 / $654.70
| Professional | | $98.65 | $319.38 | $654.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.81 / $275.61 / $508.64
| Facility | | $95.81 | $275.61 | $508.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.64 / $263.82 / $647.67
| Professional | | $110.64 | $263.82 | $647.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,271.00 / $3,866.00 / $7,608.00
| Facility | | $1,271.00 | $3,866.00 | $7,608.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.90 / $320.57 / $514.41
| Professional | | $228.90 | $320.57 | $514.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.95 / $311.58 / $423.27
| Professional | | $266.95 | $311.58 | $423.27 |