- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $148.13 / $1,825.00 / $6,049.01
| Facility | | $148.13 | $1,825.00 | $6,049.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.61 / $142.84 / $357.71
| Professional | | $86.61 | $142.84 | $357.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.47 / $119.47 / $128.16
| Professional | | $119.47 | $119.47 | $128.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,772.00 / $2,838.15 / $6,846.16
| Facility | | $1,772.00 | $2,838.15 | $6,846.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.60 / $224.39 / $254.30
| Professional | | $155.60 | $224.39 | $254.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.83 / $153.80 / $252.20
| Professional | | $99.83 | $153.80 | $252.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.92 / $240.33 / $247.51
| Professional | | $186.92 | $240.33 | $247.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $868.15 / $1,717.76 / $3,948.20
| Facility | | $868.15 | $1,717.76 | $3,948.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.65 / $145.13 / $177.00
| Professional | | $112.65 | $145.13 | $177.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $171.96 / $2,374.17 / $7,175.00
| Facility | | $171.96 | $2,374.17 | $7,175.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.96 / $150.59 / $378.13
| Professional | | $93.96 | $150.59 | $378.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.71 / $160.90 / $223.59
| Professional | | $102.71 | $160.90 | $223.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $183.87 / $183.87 / $183.87
| Facility | | $183.87 | $183.87 | $183.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.71 / $154.13 / $282.55
| Professional | | $102.71 | $154.13 | $282.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.49 / $106.56 / $155.25
| Facility | | $100.49 | $106.56 | $155.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.00 / $135.87 / $166.57
| Professional | | $104.00 | $135.87 | $166.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $412.00 / $1,219.00 / $4,300.00
| Facility | | $412.00 | $1,219.00 | $4,300.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.36 / $164.87 / $278.35
| Professional | | $131.36 | $164.87 | $278.35 |