- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $233.93 / $9,639.00 / $20,509.00
| Facility | | $233.93 | $9,639.00 | $20,509.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.53 / $233.93 / $1,232.15
| Professional | | $194.53 | $233.93 | $1,232.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,629.00 / $7,362.00 / $16,460.00
| Facility | | $2,629.00 | $7,362.00 | $16,460.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.20 / $412.79 / $760.45
| Professional | | $298.20 | $412.79 | $760.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.50 / $100.00 / $5,485.17
| Facility | | $63.50 | $100.00 | $5,485.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.60 / $291.39 / $713.85
| Professional | | $189.60 | $291.39 | $713.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.71 / $309.83 / $1,084.18
| Professional | | $240.71 | $309.83 | $1,084.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.93 / $259.12 / $323.89
| Professional | | $215.93 | $259.12 | $323.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.90 / $292.50 / $514.79
| Professional | | $224.90 | $292.50 | $514.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $3,986.10 / $4,919.58
| Facility | | $55.00 | $3,986.10 | $4,919.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,177.80 / $2,177.80 / $2,177.80
| Professional | | $2,177.80 | $2,177.80 | $2,177.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $235.52 / $314.41 / $498.85
| Facility | | $235.52 | $314.41 | $498.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.71 / $312.11 / $726.67
| Professional | | $240.71 | $312.11 | $726.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $764.51 / $764.51 / $764.51
| Professional | | $764.51 | $764.51 | $764.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.93 / $272.31 / $408.47
| Professional | | $215.93 | $272.31 | $408.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,009.00 / $5,159.00 / $20,279.00
| Facility | | $2,009.00 | $5,159.00 | $20,279.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.92 / $274.56 / $742.43
| Professional | | $199.92 | $274.56 | $742.43 |