- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $211.56 / $1,926.00 / $7,175.00
| Facility | | $211.56 | $1,926.00 | $7,175.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.56 / $198.19 / $583.78
| Professional | | $127.56 | $198.19 | $583.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,299.82 / $2,746.00 / $13,822.74
| Facility | | $2,299.82 | $2,746.00 | $13,822.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.61 / $231.30 / $231.30
| Professional | | $196.61 | $231.30 | $231.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.21 / $210.27 / $358.90
| Professional | | $135.21 | $210.27 | $358.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $10.00 / $268.33
| Professional | | $10.00 | $10.00 | $268.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,268.25 / $1,868.22 / $9,166.45
| Facility | | $1,268.25 | $1,868.22 | $9,166.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.06 / $222.92 / $241.40
| Professional | | $148.06 | $222.92 | $241.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $617.00 / $2,326.00 / $7,799.00
| Facility | | $617.00 | $2,326.00 | $7,799.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.07 / $211.56 / $628.33
| Professional | | $131.07 | $211.56 | $628.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.21 / $197.60 / $318.74
| Professional | | $139.21 | $197.60 | $318.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $249.52 / $249.52 / $249.52
| Facility | | $249.52 | $249.52 | $249.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.21 / $218.33 / $402.88
| Professional | | $139.21 | $218.33 | $402.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.90 / $147.07 / $221.36
| Facility | | $143.90 | $147.07 | $221.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.74 / $195.60 / $237.58
| Professional | | $143.74 | $195.60 | $237.58 |
- 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
- $190.36 / $244.87 / $422.09
| Professional | | $190.36 | $244.87 | $422.09 |