- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $428.00 / $2,070.00 / $7,197.00
| Facility | | $428.00 | $2,070.00 | $7,197.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.20 / $208.31 / $308.11
| Professional | | $95.20 | $208.31 | $308.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.69 / $3,159.00 / $14,886.03
| Facility | | $2,344.69 | $3,159.00 | $14,886.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.16 / $347.51 / $426.60
| Professional | | $256.16 | $347.51 | $426.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $180.85 / $180.85 / $180.85
| Facility | | $180.85 | $180.85 | $180.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.46 / $210.71 / $424.38
| Professional | | $107.46 | $210.71 | $424.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.59 / $410.72 / $532.66
| Professional | | $118.59 | $410.72 | $532.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $677.81 / $2,459.29 / $3,074.09
| Facility | | $677.81 | $2,459.29 | $3,074.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $641.00 / $2,266.00 / $8,017.00
| Facility | | $641.00 | $2,266.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.18 / $229.07 / $677.76
| Professional | | $96.18 | $229.07 | $677.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.70 / $249.70 / $568.70
| Professional | | $249.70 | $249.70 | $568.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $180.85 / $180.85 / $180.85
| Facility | | $180.85 | $180.85 | $180.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.46 / $210.71 / $430.35
| Professional | | $107.46 | $210.71 | $430.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.78 / $108.86 / $258.64
| Facility | | $102.78 | $108.86 | $258.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.78 / $240.71 / $279.08
| Professional | | $102.78 | $240.71 | $279.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $471.00 / $1,305.00 / $3,742.00
| Facility | | $471.00 | $1,305.00 | $3,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.55 / $320.97 / $480.86
| Professional | | $243.55 | $320.97 | $480.86 |