- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $183.88 / $2,371.00 / $7,629.00
| Facility | | $183.88 | $2,371.00 | $7,629.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.07 / $170.34 / $339.71
| Professional | | $105.07 | $170.34 | $339.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $990.00 / $2,594.00 / $5,296.01
| Facility | | $990.00 | $2,594.00 | $5,296.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.91 / $199.16 / $346.17
| Professional | | $191.91 | $199.16 | $346.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.63 / $180.55 / $301.44
| Professional | | $111.63 | $180.55 | $301.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $10.00 / $231.95
| Professional | | $10.00 | $10.00 | $231.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,869.79 / $1,869.79 / $1,869.79
| Facility | | $1,869.79 | $1,869.79 | $1,869.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.51 / $197.09 / $197.09
| Professional | | $189.51 | $197.09 | $197.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $594.00 / $2,422.00 / $8,017.00
| Facility | | $594.00 | $2,422.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.70 / $176.27 / $732.76
| Professional | | $105.70 | $176.27 | $732.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.48 / $168.00 / $278.61
| Professional | | $114.48 | $168.00 | $278.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.99 / $204.99 / $204.99
| Facility | | $204.99 | $204.99 | $204.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.72 / $181.61 / $331.01
| Professional | | $112.72 | $181.61 | $331.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.82 / $118.58 / $191.30
| Facility | | $102.82 | $118.58 | $191.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.62 / $158.16 / $205.80
| Professional | | $115.62 | $158.16 | $205.80 |
- 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
- $154.32 / $205.94 / $342.60
| Professional | | $154.32 | $205.94 | $342.60 |