- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.13 / $1,978.00 / $7,629.00
| Facility | | $190.13 | $1,978.00 | $7,629.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.76 / $178.68 / $313.37
| Professional | | $111.76 | $178.68 | $313.37 |
- 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
- $179.04 / $210.64 / $210.64
| Professional | | $179.04 | $210.64 | $210.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.47 / $190.06 / $325.51
| Professional | | $120.47 | $190.06 | $325.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.39 / $312.93 / $322.20
| Professional | | $243.39 | $312.93 | $322.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,241.94 / $2,241.94 / $2,241.94
| Facility | | $2,241.94 | $2,241.94 | $2,241.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.67 / $198.74 / $266.85
| Professional | | $190.67 | $198.74 | $266.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $543.82 / $2,326.00 / $8,017.00
| Facility | | $543.82 | $2,326.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.45 / $182.05 / $354.58
| Professional | | $116.45 | $182.05 | $354.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.43 / $181.80 / $285.08
| Professional | | $123.43 | $181.80 | $285.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $221.72 / $221.72 / $221.72
| Facility | | $221.72 | $221.72 | $221.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.82 / $197.37 / $364.65
| Professional | | $123.82 | $197.37 | $364.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.38 / $130.80 / $200.36
| Facility | | $126.38 | $130.80 | $200.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.25 / $190.40 / $214.66
| Professional | | $126.25 | $190.40 | $214.66 |
- 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
- $171.84 / $217.67 / $378.60
| Professional | | $171.84 | $217.67 | $378.60 |