- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $256.52 / $1,740.00 / $6,408.56
| Facility | | $256.52 | $1,740.00 | $6,408.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.21 / $256.52 / $479.77
| Professional | | $179.21 | $256.52 | $479.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.62 / $124.62 / $124.62
| Professional | | $124.62 | $124.62 | $124.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,736.00 / $4,444.00 / $15,949.31
| Facility | | $3,736.00 | $4,444.00 | $15,949.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.32 / $301.27 / $495.57
| Professional | | $290.32 | $301.27 | $495.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.64 / $277.39 / $485.57
| Professional | | $186.64 | $277.39 | $485.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.04 / $447.48 / $461.29
| Professional | | $348.04 | $447.48 | $461.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,239.60 / $3,918.89 / $7,262.42
| Facility | | $3,239.60 | $3,918.89 | $7,262.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.08 / $283.77 / $295.27
| Professional | | $272.08 | $283.77 | $295.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $296.29 / $1,945.69 / $7,175.00
| Facility | | $296.29 | $1,945.69 | $7,175.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.89 / $272.52 / $558.83
| Professional | | $179.89 | $272.52 | $558.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.22 / $273.18 / $414.41
| Professional | | $196.22 | $273.18 | $414.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $352.47 / $352.47 / $352.47
| Facility | | $352.47 | $352.47 | $352.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.94 / $287.58 / $523.16
| Professional | | $191.94 | $287.58 | $523.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $203.35 / $205.05 / $287.45
| Facility | | $203.35 | $205.05 | $287.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.35 / $262.44 / $307.29
| Professional | | $203.35 | $262.44 | $307.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $471.00 / $1,219.00 / $3,742.00
| Facility | | $471.00 | $1,219.00 | $3,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.18 / $321.75 / $553.40
| Professional | | $251.18 | $321.75 | $553.40 |