- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.52 / $1,284.00 / $7,629.00
| Facility | | $157.52 | $1,284.00 | $7,629.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.84 / $147.59 / $283.11
| Professional | | $101.84 | $147.59 | $283.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.27 / $142.27 / $142.27
| Professional | | $142.27 | $142.27 | $142.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,736.00 / $4,444.00 / $15,949.31
| Facility | | $3,736.00 | $4,444.00 | $15,949.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.72 / $286.93 / $286.93
| Professional | | $165.72 | $286.93 | $286.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.99 / $163.90 / $267.44
| Professional | | $113.99 | $163.90 | $267.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.65 / $256.69 / $264.70
| Professional | | $199.65 | $256.69 | $264.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $916.86 / $3,429.97 / $11,029.83
| Facility | | $916.86 | $3,429.97 | $11,029.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.07 / $169.60 / $190.01
| Professional | | $163.07 | $169.60 | $190.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.36 / $1,886.35 / $7,279.37
| Facility | | $186.36 | $1,886.35 | $7,279.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.45 / $166.97 / $335.19
| Professional | | $106.45 | $166.97 | $335.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.19 / $162.26 / $244.86
| Professional | | $120.19 | $162.26 | $244.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.93 / $199.93 / $199.93
| Facility | | $199.93 | $199.93 | $199.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.25 / $164.16 / $291.64
| Professional | | $117.25 | $164.16 | $291.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $111.31 / $114.38 / $163.69
| Facility | | $111.31 | $114.38 | $163.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.59 / $140.04 / $175.56
| Professional | | $111.59 | $140.04 | $175.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $637.00 / $2,391.00 / $6,000.00
| Facility | | $637.00 | $2,391.00 | $6,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.56 / $179.51 / $296.55
| Professional | | $138.56 | $179.51 | $296.55 |