- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.89 / $1,473.20 / $3,363.00
| Facility | | $389.89 | $1,473.20 | $3,363.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.92 / $153.94 / $511.09
| Professional | | $64.92 | $153.94 | $511.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.58 / $1,546.15 / $7,958.00
| Facility | | $263.58 | $1,546.15 | $7,958.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.47 / $204.41 / $829.12
| Professional | | $106.47 | $204.41 | $829.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.43 / $118.86 / $209.74
| Facility | | $91.43 | $118.86 | $209.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.48 / $177.62 / $394.14
| Professional | | $116.48 | $177.62 | $394.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $297.61 / $498.00 / $921.44
| Facility | | $297.61 | $498.00 | $921.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.86 / $194.76 / $330.08
| Professional | | $104.86 | $194.76 | $330.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $267.81 / $6,679.00
| Facility | | $83.43 | $267.81 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.94 / $140.46 / $215.78
| Professional | | $72.94 | $140.46 | $215.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.60 / $218.76 / $322.82
| Professional | | $101.60 | $218.76 | $322.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,041.92 / $1,087.72 / $1,127.83
| Facility | | $1,041.92 | $1,087.72 | $1,127.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.84 / $127.33 / $244.63
| Professional | | $119.84 | $127.33 | $244.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $383.37 / $2,430.00 / $11,500.00
| Facility | | $383.37 | $2,430.00 | $11,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.68 / $302.47 / $829.12
| Professional | | $155.68 | $302.47 | $829.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.00 / $2,408.00 / $5,683.00
| Facility | | $1,106.00 | $2,408.00 | $5,683.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.38 / $186.21 / $348.50
| Professional | | $154.38 | $186.21 | $348.50 |