- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.61 / $3,205.00 / $7,521.00
| Facility | | $244.61 | $3,205.00 | $7,521.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.43 / $269.72 / $548.22
| Professional | | $157.43 | $269.72 | $548.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,283.00 / $5,160.00 / $11,809.00
| Facility | | $3,283.00 | $5,160.00 | $11,809.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.81 / $301.54 / $714.68
| Professional | | $237.81 | $301.54 | $714.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.66 / $1,716.00 / $6,213.00
| Facility | | $204.66 | $1,716.00 | $6,213.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.66 / $204.66 / $428.58
| Professional | | $204.66 | $204.66 | $428.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $252.93 / $252.93 / $4,612.43
| Facility | | $252.93 | $252.93 | $4,612.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.48 / $387.85 / $984.90
| Professional | | $178.48 | $387.85 | $984.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $171.95 / $250.00 / $386.89
| Facility | | $171.95 | $250.00 | $386.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.45 / $406.75 / $608.73
| Professional | | $315.45 | $406.75 | $608.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.54 / $331.16 / $562.14
| Professional | | $242.54 | $331.16 | $562.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $252.93 / $597.00 / $8,498.00
| Facility | | $252.93 | $597.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.31 / $428.35 / $1,015.33
| Professional | | $208.31 | $428.35 | $1,015.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,066.00 / $3,682.00 / $7,203.00
| Facility | | $2,066.00 | $3,682.00 | $7,203.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.36 / $374.67 / $843.07
| Professional | | $241.36 | $374.67 | $843.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $161.44 / $161.44 / $592.42
| Facility | | $161.44 | $161.44 | $592.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.54 / $379.29 / $614.22
| Professional | | $211.54 | $379.29 | $614.22 |