- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.74 / $1,378.81 / $6,012.00
| Facility | | $153.74 | $1,378.81 | $6,012.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.28 / $153.15 / $273.05
| Professional | | $109.28 | $153.15 | $273.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.06 / $155.06 / $155.06
| Professional | | $155.06 | $155.06 | $155.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,299.82 / $2,746.00 / $13,822.74
| Facility | | $2,299.82 | $2,746.00 | $13,822.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.34 / $171.58 / $280.52
| Professional | | $165.34 | $171.58 | $280.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.09 / $169.35 / $288.22
| Professional | | $120.09 | $169.35 | $288.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.34 / $252.44 / $260.13
| Professional | | $196.34 | $252.44 | $260.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $769.34 / $769.34 / $1,696.33
| Facility | | $769.34 | $769.34 | $1,696.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.37 / $160.52 / $313.77
| Professional | | $127.37 | $160.52 | $313.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $428.00 / $1,819.00 / $7,197.00
| Facility | | $428.00 | $1,819.00 | $7,197.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.87 / $158.19 / $673.05
| Professional | | $111.87 | $158.19 | $673.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.00 / $157.19 / $237.29
| Professional | | $117.00 | $157.19 | $237.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $211.32 / $211.32 / $211.32
| Facility | | $211.32 | $211.32 | $211.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.37 / $172.04 / $317.80
| Professional | | $121.37 | $172.04 | $317.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $121.39 / $123.41 / $163.76
| Facility | | $121.39 | $123.41 | $163.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.39 / $144.15 / $173.82
| Professional | | $121.39 | $144.15 | $173.82 |
- 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
- $142.56 / $190.42 / $325.12
| Professional | | $142.56 | $190.42 | $325.12 |