- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $121.26 / $2,240.00 / $7,175.00
| Facility | | $121.26 | $2,240.00 | $7,175.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.31 / $121.26 / $448.80
| Professional | | $108.31 | $121.26 | $448.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,531.00 / $27,840.00 / $46,296.00
| Facility | | $13,531.00 | $27,840.00 | $46,296.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.65 / $95.11 / $97.96
| Professional | | $91.65 | $95.11 | $97.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.69 / $131.69 / $131.69
| Facility | | $131.69 | $131.69 | $131.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.89 / $145.72 / $235.63
| Professional | | $111.89 | $145.72 | $235.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.23 / $347.40 / $487.48
| Professional | | $282.23 | $347.40 | $487.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $506.57 / $2,763.02 / $5,594.60
| Facility | | $506.57 | $2,763.02 | $5,594.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.88 / $129.43 / $685.40
| Professional | | $110.88 | $129.43 | $685.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $198.22 / $1,978.00 / $8,017.00
| Facility | | $198.22 | $1,978.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.42 / $127.01 / $554.40
| Professional | | $105.42 | $127.01 | $554.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.40 / $351.40 / $351.40
| Professional | | $351.40 | $351.40 | $351.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.69 / $131.69 / $131.69
| Facility | | $131.69 | $131.69 | $131.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.28 / $146.04 / $247.42
| Professional | | $110.28 | $146.04 | $247.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $163.71 / $163.71 / $163.71
| Facility | | $163.71 | $163.71 | $163.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.71 / $163.71 / $163.71
| Professional | | $163.71 | $163.71 | $163.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.00 / $650.00 / $3,742.00
| Facility | | $162.00 | $650.00 | $3,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.92 / $145.62 / $253.07
| Professional | | $104.92 | $145.62 | $253.07 |