- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.74 / $2,605.00 / $7,799.00
| Facility | | $323.74 | $2,605.00 | $7,799.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.15 / $269.47 / $499.84
| Professional | | $148.15 | $269.47 | $499.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,058.35 / $6,182.00 / $17,094.48
| Facility | | $5,058.35 | $6,182.00 | $17,094.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.95 / $301.94 / $514.09
| Professional | | $290.95 | $301.94 | $514.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $272.08 / $272.08 / $272.08
| Facility | | $272.08 | $272.08 | $272.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.97 / $275.95 / $492.60
| Professional | | $158.97 | $275.95 | $492.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.67 / $473.55 / $609.16
| Professional | | $352.67 | $473.55 | $609.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.38 / $180.82 / $306.04
| Professional | | $164.38 | $180.82 | $306.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $594.00 / $2,605.00 / $8,017.00
| Facility | | $594.00 | $2,605.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.38 / $285.32 / $802.77
| Professional | | $156.38 | $285.32 | $802.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.50 / $281.39 / $652.90
| Professional | | $274.50 | $281.39 | $652.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $272.08 / $272.08 / $272.08
| Facility | | $272.08 | $272.08 | $272.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.46 / $285.79 / $528.34
| Professional | | $162.46 | $285.79 | $528.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.51 / $201.98 / $294.10
| Facility | | $157.51 | $201.98 | $294.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.47 / $282.05 / $318.43
| Professional | | $157.47 | $282.05 | $318.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $814.00 / $2,391.00 / $4,789.00
| Facility | | $814.00 | $2,391.00 | $4,789.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.27 / $348.95 / $533.29
| Professional | | $256.27 | $348.95 | $533.29 |