- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $445.80 / $2,107.00 / $6,762.00
| Facility | | $445.80 | $2,107.00 | $6,762.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.35 / $389.34 / $556.22
| Professional | | $123.35 | $389.34 | $556.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,943.95 / $3,563.15 / $7,196.63
| Facility | | $1,943.95 | $3,563.15 | $7,196.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.50 / $353.20 / $645.03
| Professional | | $118.50 | $353.20 | $645.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $118.05 / $118.05 / $445.85
| Facility | | $118.05 | $118.05 | $445.85 |
- 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
- $144.21 / $390.98 / $767.86
| Professional | | $144.21 | $390.98 | $767.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.88 / $11,500.00 / $12,000.00
| Facility | | $890.88 | $11,500.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,635.44 / $3,124.08 / $3,684.75
| Professional | | $1,635.44 | $3,124.08 | $3,684.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.97 / $391.23 / $674.47
| Facility | | $126.97 | $391.23 | $674.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.84 / $465.05 / $760.99
| Professional | | $164.84 | $465.05 | $760.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.06 / $446.00 / $957.41
| Professional | | $135.06 | $446.00 | $957.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $127.22 / $400.23 / $739.73
| Facility | | $127.22 | $400.23 | $739.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.44 / $425.58 / $939.05
| Professional | | $149.44 | $425.58 | $939.05 |
- 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
- $349.37 / $465.83 / $734.93
| Professional | | $349.37 | $465.83 | $734.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.82 / $421.83 / $573.42
| Professional | | $360.82 | $421.83 | $573.42 |