- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $432.07 / $5,382.00 / $16,713.00
| Facility | | $432.07 | $5,382.00 | $16,713.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.81 / $397.68 / $1,570.74
| Professional | | $241.81 | $397.68 | $1,570.74 |
- 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
- $236.87 / $381.74 / $854.19
| Professional | | $236.87 | $381.74 | $854.19 |
- 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
- $243.71 / $348.15 / $775.85
| Professional | | $243.71 | $348.15 | $775.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.16 / $464.48 / $909.44
| Professional | | $289.16 | $464.48 | $909.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.94 / $394.69 / $737.93
| Professional | | $231.94 | $394.69 | $737.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.54 / $527.70 / $940.47
| Professional | | $304.54 | $527.70 | $940.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,058.23 / $2,109.23 / $16,394.00
| Facility | | $2,058.23 | $2,109.23 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,166.88 / $3,579.28 / $4,233.08
| Professional | | $2,166.88 | $3,579.28 | $4,233.08 |
- 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
- $301.55 / $443.07 / $716.39
| Facility | | $301.55 | $443.07 | $716.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.57 / $492.21 / $967.26
| Professional | | $293.57 | $492.21 | $967.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $974.60 / $974.60 / $1,606.94
| Professional | | $974.60 | $974.60 | $1,606.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.00 / $380.88 / $683.14
| Professional | | $277.00 | $380.88 | $683.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $587.00 / $1,533.00 / $5,830.00
| Facility | | $587.00 | $1,533.00 | $5,830.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.08 / $473.28 / $1,218.76
| Professional | | $358.08 | $473.28 | $1,218.76 |