- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.15 / $1,411.87 / $3,685.00
| Facility | | $207.15 | $1,411.87 | $3,685.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.59 / $148.38 / $408.34
| Professional | | $86.59 | $148.38 | $408.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $286.33 / $1,251.81 / $7,161.00
| Facility | | $286.33 | $1,251.81 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.66 / $259.32 / $846.32
| Professional | | $129.66 | $259.32 | $846.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $139.16 / $180.91 / $319.23
| Facility | | $139.16 | $180.91 | $319.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.33 / $272.63 / $375.55
| Professional | | $181.33 | $272.63 | $375.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.31 / $232.49 / $475.23
| Professional | | $131.31 | $232.49 | $475.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $119.20 / $214.32 / $6,679.00
| Facility | | $119.20 | $214.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.70 / $242.87 / $335.72
| Professional | | $191.70 | $242.87 | $335.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.77 / $304.36 / $507.87
| Professional | | $143.77 | $304.36 | $507.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.88 / $500.38 / $769.12
| Facility | | $160.88 | $500.38 | $769.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.31 / $179.43 / $264.81
| Professional | | $111.31 | $179.43 | $264.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $596.13 / $2,078.00 / $11,500.00
| Facility | | $596.13 | $2,078.00 | $11,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.72 / $315.83 / $1,240.00
| Professional | | $181.72 | $315.83 | $1,240.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.47 / $182.85 / $369.26
| Professional | | $135.47 | $182.85 | $369.26 |
- 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
- $147.26 / $244.70 / $507.58
| Professional | | $147.26 | $244.70 | $507.58 |