- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $164.05 / $1,685.07 / $7,175.00
| Facility | | $164.05 | $1,685.07 | $7,175.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.41 / $154.04 / $407.53
| Professional | | $83.41 | $154.04 | $407.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,083.51 / $1,395.00 / $12,759.45
| Facility | | $1,083.51 | $1,395.00 | $12,759.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.68 / $180.24 / $378.59
| Professional | | $173.68 | $180.24 | $378.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.64 / $172.04 / $326.44
| Professional | | $93.64 | $172.04 | $326.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.02 / $270.02 / $279.57
| Professional | | $210.02 | $270.02 | $279.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $752.85 / $1,074.80 / $2,470.13
| Facility | | $752.85 | $1,074.80 | $2,470.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.52 / $162.52 / $162.52
| Professional | | $162.52 | $162.52 | $162.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.89 / $2,202.00 / $7,799.00
| Facility | | $281.89 | $2,202.00 | $7,799.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.29 / $164.05 / $778.14
| Professional | | $86.29 | $164.05 | $778.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.24 / $256.89 / $256.89
| Professional | | $94.24 | $256.89 | $256.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.44 / $162.44 / $162.44
| Facility | | $162.44 | $162.44 | $162.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.46 / $175.62 / $359.71
| Professional | | $95.46 | $175.62 | $359.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $92.98 / $155.40 / $217.40
| Facility | | $92.98 | $155.40 | $217.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.98 / $167.68 / $183.67
| Professional | | $92.98 | $167.68 | $183.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.00 / $674.00 / $4,300.00
| Facility | | $144.00 | $674.00 | $4,300.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.84 / $199.80 / $335.29
| Professional | | $152.84 | $199.80 | $335.29 |