- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $5,370.32 / $8,511.38
| Facility | | $537.03 | $5,370.32 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $158.49 / $407.38
| Professional | | $83.18 | $158.49 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $158.49 / $158.49
| Professional | | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,258.93 / $57,543.99
| Facility | | $1,174.90 | $1,258.93 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $154.88 / $263.03
| Professional | | $89.13 | $154.88 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $275.42 / $302.00
| Professional | | $213.80 | $275.42 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $199.53 / $309.03
| Professional | | $120.23 | $199.53 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $467.74
| Facility | | $467.74 | $467.74 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $177.83 / $302.00
| Professional | | $169.82 | $177.83 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $3,981.07 / $8,317.64
| Facility | | $588.84 | $3,981.07 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $162.18 / $363.08
| Professional | | $85.11 | $162.18 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $147.91 / $147.91
| Professional | | $147.91 | $147.91 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.90 / $102.33 / $186.21
| Facility | | $38.90 | $102.33 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $154.88 / $186.21
| Professional | | $69.18 | $154.88 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $1,071.52 / $3,890.45
| Facility | | $223.87 | $1,071.52 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $151.36 / $263.03
| Professional | | $87.10 | $151.36 | $263.03 |