- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.59 / $1,245.00 / $6,953.60
| Facility | | $175.59 | $1,245.00 | $6,953.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.72 / $178.52 / $351.12
| Professional | | $161.72 | $178.52 | $351.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,996.19 / $2,195.80 / $3,726.21
| Facility | | $1,996.19 | $2,195.80 | $3,726.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.52 / $335.37 / $464.32
| Professional | | $182.52 | $335.37 | $464.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.44 / $1,436.38 / $2,709.73
| Facility | | $323.44 | $1,436.38 | $2,709.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.14 / $253.65 / $452.68
| Professional | | $169.14 | $253.65 | $452.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.59 / $203.11 / $305.08
| Facility | | $175.59 | $203.11 | $305.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.00 / $399.00 / $1,125.35
| Professional | | $237.00 | $399.00 | $1,125.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.10 / $198.70 / $370.90
| Professional | | $168.10 | $198.70 | $370.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $773.00 / $1,208.00 / $9,324.00
| Facility | | $773.00 | $1,208.00 | $9,324.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.84 / $196.69 / $411.07
| Professional | | $142.84 | $196.69 | $411.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.36 / $7,929.30 / $12,000.00
| Facility | | $1,020.36 | $7,929.30 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,295.04 / $1,295.04 / $1,576.58
| Professional | | $1,295.04 | $1,295.04 | $1,576.58 |