- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $237.78 / $2,017.00 / $7,316.00
| Facility | | $237.78 | $2,017.00 | $7,316.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.73 / $145.79 / $230.35
| Professional | | $91.73 | $145.79 | $230.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $556.29 / $1,000.08 / $2,231.42
| Facility | | $556.29 | $1,000.08 | $2,231.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.72 / $152.26 / $218.12
| Professional | | $91.72 | $152.26 | $218.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $86.47 / $87.86
| Facility | | $80.00 | $86.47 | $87.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $168.21 / $168.21 / $168.21
| Facility | | $168.21 | $168.21 | $168.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.94 / $176.93 / $285.04
| Professional | | $109.94 | $176.93 | $285.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $481.60
| Facility | | $55.00 | $55.00 | $481.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $714.32 / $822.90 / $1,332.08
| Professional | | $714.32 | $822.90 | $1,332.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.08 / $153.88 / $250.18
| Facility | | $95.08 | $153.88 | $250.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.48 / $178.10 / $277.14
| Professional | | $124.48 | $178.10 | $277.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.96 / $188.77 / $354.12
| Professional | | $108.96 | $188.77 | $354.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.39 / $153.88 / $261.08
| Facility | | $95.39 | $153.88 | $261.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.94 / $183.25 / $308.92
| Professional | | $109.94 | $183.25 | $308.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $374.00 / $1,529.00 / $3,400.00
| Facility | | $374.00 | $1,529.00 | $3,400.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.34 / $175.96 / $286.52
| Professional | | $129.34 | $175.96 | $286.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.41 / $148.61 / $208.21
| Professional | | $131.41 | $148.61 | $208.21 |