- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $188.84 / $2,679.00 / $8,017.00
| Facility | | $188.84 | $2,679.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.58 / $176.35 / $334.79
| Professional | | $108.58 | $176.35 | $334.79 |
- 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
- $197.73 / $205.19 / $357.60
| Professional | | $197.73 | $205.19 | $357.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.53 / $183.84 / $310.48
| Professional | | $115.53 | $183.84 | $310.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.94 / $307.20 / $316.74
| Professional | | $238.94 | $307.20 | $316.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,579.25 / $1,579.25 / $2,763.73
| Facility | | $1,579.25 | $1,579.25 | $2,763.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.27 / $201.27 / $201.27
| Professional | | $201.27 | $201.27 | $201.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.00 / $3,077.00 / $8,017.00
| Facility | | $832.00 | $3,077.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.23 / $188.84 / $762.74
| Professional | | $114.23 | $188.84 | $762.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.77 / $182.40 / $284.13
| Professional | | $118.77 | $182.40 | $284.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $212.59 / $212.59 / $212.59
| Facility | | $212.59 | $212.59 | $212.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.77 / $190.07 / $350.69
| Professional | | $118.77 | $190.07 | $350.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.05 / $122.49 / $196.47
| Facility | | $120.05 | $122.49 | $196.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.05 / $168.84 / $211.35
| Professional | | $120.05 | $168.84 | $211.35 |
- 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
- $165.26 / $216.00 / $391.46
| Professional | | $165.26 | $216.00 | $391.46 |