- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $184.49 / $2,240.00 / $7,197.00
| Facility | | $184.49 | $2,240.00 | $7,197.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.67 / $172.27 / $340.39
| Professional | | $105.67 | $172.27 | $340.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $990.00 / $2,838.15 / $6,846.16
| Facility | | $990.00 | $2,838.15 | $6,846.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.57 / $199.84 / $199.84
| Professional | | $192.57 | $199.84 | $199.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.53 / $179.48 / $303.01
| Professional | | $112.53 | $179.48 | $303.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.00 / $232.88 / $308.82
| Professional | | $48.00 | $232.88 | $308.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,088.44 / $4,400.35 / $5,727.05
| Facility | | $1,088.44 | $4,400.35 | $5,727.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.98 / $195.98 / $195.98
| Professional | | $195.98 | $195.98 | $195.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $594.00 / $2,371.00 / $8,017.00
| Facility | | $594.00 | $2,371.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.31 / $181.15 / $740.38
| Professional | | $107.31 | $181.15 | $740.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.40 / $168.04 / $279.07
| Professional | | $115.40 | $168.04 | $279.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.65 / $206.65 / $206.65
| Facility | | $206.65 | $206.65 | $206.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.45 / $182.66 / $337.28
| Professional | | $113.45 | $182.66 | $337.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.76 / $119.24 / $192.27
| Facility | | $89.76 | $119.24 | $192.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.27 / $137.57 / $206.84
| Professional | | $116.27 | $137.57 | $206.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $412.00 / $1,155.00 / $3,742.00
| Facility | | $412.00 | $1,155.00 | $3,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.24 / $207.43 / $384.19
| Professional | | $161.24 | $207.43 | $384.19 |