- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $237.22 / $2,131.00 / $6,691.00
| Facility | | $237.22 | $2,131.00 | $6,691.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.14 / $193.40 / $271.58
| Professional | | $115.14 | $193.40 | $271.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,213.23 / $2,168.71 / $4,246.29
| Facility | | $1,213.23 | $2,168.71 | $4,246.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.77 / $186.53 / $311.73
| Professional | | $110.77 | $186.53 | $311.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.48 / $81.48 / $101.93
| Facility | | $81.48 | $81.48 | $101.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,016.69 / $1,016.69 / $1,016.69
| Facility | | $1,016.69 | $1,016.69 | $1,016.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $224.04 / $370.65
| Professional | | $134.90 | $224.04 | $370.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.66 / $12,000.00 / $12,000.00
| Facility | | $612.66 | $12,000.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $890.24 / $3,577.25 / $3,577.25
| Professional | | $890.24 | $3,577.25 | $3,577.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $118.91 / $206.93 / $355.91
| Facility | | $118.91 | $206.93 | $355.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.32 / $255.24 / $353.41
| Professional | | $154.32 | $255.24 | $353.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.89 / $261.89 / $261.89
| Professional | | $261.89 | $261.89 | $261.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $118.91 / $207.74 / $393.80
| Facility | | $118.91 | $207.74 | $393.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.65 / $230.42 / $379.04
| Professional | | $139.65 | $230.42 | $379.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $564.00 / $2,064.00 / $4,509.00
| Facility | | $564.00 | $2,064.00 | $4,509.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.69 / $225.09 / $357.28
| Professional | | $163.69 | $225.09 | $357.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.57 / $188.85 / $266.06
| Professional | | $167.57 | $188.85 | $266.06 |