- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $382.01 / $2,128.00 / $7,513.00
| Facility | | $382.01 | $2,128.00 | $7,513.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.47 / $284.07 / $480.48
| Professional | | $146.47 | $284.07 | $480.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.19 / $1,315.52 / $2,679.76
| Facility | | $707.19 | $1,315.52 | $2,679.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.66 / $255.12 / $417.05
| Professional | | $144.66 | $255.12 | $417.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $133.94 / $135.19
| Facility | | $80.00 | $133.94 | $135.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $271.44 / $271.44 / $271.44
| Facility | | $271.44 | $271.44 | $271.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.94 / $310.33 / $560.00
| Professional | | $176.94 | $310.33 | $560.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $917.20 / $11,500.00 / $12,000.00
| Facility | | $917.20 | $11,500.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,215.49 / $2,328.56 / $2,704.20
| Professional | | $1,215.49 | $2,328.56 | $2,704.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $155.79 / $314.14 / $525.69
| Facility | | $155.79 | $314.14 | $525.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.68 / $359.71 / $563.02
| Professional | | $202.68 | $359.71 | $563.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.77 / $330.19 / $652.21
| Professional | | $173.77 | $330.19 | $652.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $155.83 / $316.25 / $535.97
| Facility | | $155.83 | $316.25 | $535.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.94 / $327.89 / $620.54
| Professional | | $176.94 | $327.89 | $620.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $374.00 / $1,529.00 / $3,287.00
| Facility | | $374.00 | $1,529.00 | $3,287.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.49 / $357.60 / $570.54
| Professional | | $268.49 | $357.60 | $570.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.95 / $300.17 / $424.09
| Professional | | $266.95 | $300.17 | $424.09 |