- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.55 / $4,963.00 / $16,210.00
| Facility | | $425.55 | $4,963.00 | $16,210.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.57 / $309.33 / $1,078.38
| Professional | | $191.57 | $309.33 | $1,078.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,143.00 / $5,863.00 / $11,400.00
| Facility | | $2,143.00 | $5,863.00 | $11,400.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.19 / $314.45 / $686.32
| Professional | | $196.19 | $314.45 | $686.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.00 / $100.00 / $6,881.37
| Facility | | $66.00 | $100.00 | $6,881.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.61 / $282.77 / $604.52
| Professional | | $190.61 | $282.77 | $604.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.38 / $363.36 / $702.44
| Professional | | $222.38 | $363.36 | $702.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.99 / $288.39 / $563.66
| Professional | | $155.99 | $288.39 | $563.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.14 / $391.92 / $716.94
| Professional | | $222.14 | $391.92 | $716.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,506.90 / $2,165.76 / $16,394.00
| Facility | | $1,506.90 | $2,165.76 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,594.80 / $2,732.88 / $3,199.58
| Professional | | $1,594.80 | $2,732.88 | $3,199.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $224.27 / $333.21 / $547.58
| Facility | | $224.27 | $333.21 | $547.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.89 / $381.25 / $741.76
| Professional | | $222.89 | $381.25 | $741.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $715.81 / $715.81 / $1,241.15
| Professional | | $715.81 | $715.81 | $1,241.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.46 / $278.39 / $521.94
| Professional | | $202.46 | $278.39 | $521.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $570.00 / $1,533.00 / $5,830.00
| Facility | | $570.00 | $1,533.00 | $5,830.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.72 / $368.75 / $928.52
| Professional | | $278.72 | $368.75 | $928.52 |