- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $212.18 / $1,978.00 / $8,017.00
| Facility | | $212.18 | $1,978.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.15 / $198.78 / $377.21
| Professional | | $128.15 | $198.78 | $377.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,751.04 / $2,594.00 / $5,296.01
| Facility | | $1,751.04 | $2,594.00 | $5,296.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.18 / $232.64 / $410.26
| Professional | | $224.18 | $232.64 | $410.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.82 / $211.49 / $359.96
| Professional | | $135.82 | $211.49 | $359.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.00 / $270.22 / $358.23
| Professional | | $72.00 | $270.22 | $358.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $909.05 / $1,467.79 / $3,158.52
| Facility | | $909.05 | $1,467.79 | $3,158.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.57 / $220.08 / $295.51
| Professional | | $202.57 | $220.08 | $295.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $536.00 / $2,326.00 / $8,017.00
| Facility | | $536.00 | $2,326.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.41 / $211.06 / $630.16
| Professional | | $134.41 | $211.06 | $630.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.43 / $205.30 / $320.61
| Professional | | $140.43 | $205.30 | $320.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.73 / $251.73 / $251.73
| Facility | | $251.73 | $251.73 | $251.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.43 / $219.35 / $405.21
| Professional | | $140.43 | $219.35 | $405.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.86 / $149.68 / $222.64
| Facility | | $144.86 | $149.68 | $222.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.75 / $197.39 / $238.96
| Professional | | $144.75 | $197.39 | $238.96 |
- 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
- $192.18 / $246.85 / $424.05
| Professional | | $192.18 | $246.85 | $424.05 |