- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $254.20 / $2,070.00 / $7,197.00
| Facility | | $254.20 | $2,070.00 | $7,197.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.47 / $216.45 / $286.27
| Professional | | $144.47 | $216.45 | $286.27 |
- 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
- $254.24 / $263.83 / $444.80
| Professional | | $254.24 | $263.83 | $444.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.43 / $269.43 / $269.43
| Facility | | $269.43 | $269.43 | $269.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.91 / $242.56 / $440.25
| Professional | | $157.91 | $242.56 | $440.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.63 / $413.12 / $529.63
| Professional | | $306.63 | $413.12 | $529.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,611.71 / $5,611.71 / $5,611.71
| Facility | | $5,611.71 | $5,611.71 | $5,611.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $617.00 / $2,326.00 / $8,017.00
| Facility | | $617.00 | $2,326.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.15 / $238.95 / $824.54
| Professional | | $152.15 | $238.95 | $824.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.40 / $206.40 / $551.29
| Professional | | $206.40 | $206.40 | $551.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.43 / $269.43 / $269.43
| Facility | | $269.43 | $269.43 | $269.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.72 / $251.84 / $445.49
| Professional | | $158.72 | $251.84 | $445.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.65 / $153.46 / $240.41
| Facility | | $138.65 | $153.46 | $240.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.93 / $178.13 / $258.80
| Professional | | $148.93 | $178.13 | $258.80 |
- 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
- $203.41 / $275.20 / $453.64
| Professional | | $203.41 | $275.20 | $453.64 |