- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $216.92 / $2,240.00 / $7,629.00
| Facility | | $216.92 | $2,240.00 | $7,629.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.82 / $176.02 / $258.38
| Professional | | $124.82 | $176.02 | $258.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,736.00 / $4,444.00 / $15,949.31
| Facility | | $3,736.00 | $4,444.00 | $15,949.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.40 / $196.55 / $332.88
| Professional | | $189.40 | $196.55 | $332.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $358.00 / $358.00 / $358.00
| Facility | | $358.00 | $358.00 | $358.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.64 / $173.57 / $277.83
| Professional | | $113.64 | $173.57 | $277.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.23 / $233.23 / $300.75
| Professional | | $233.23 | $233.23 | $300.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,352.05 / $7,352.05 / $9,336.90
| Facility | | $7,352.05 | $7,352.05 | $9,336.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.77 / $238.77 / $238.77
| Professional | | $238.77 | $238.77 | $238.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $617.00 / $2,371.00 / $8,017.00
| Facility | | $617.00 | $2,371.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.82 / $190.13 / $1,023.00
| Professional | | $124.82 | $190.13 | $1,023.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.80 / $172.80 / $172.80
| Professional | | $172.80 | $172.80 | $172.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $358.00 / $358.00 / $358.00
| Facility | | $358.00 | $358.00 | $358.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.44 / $173.57 / $277.83
| Professional | | $117.44 | $173.57 | $277.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $116.02 / $125.65 / $189.20
| Facility | | $116.02 | $125.65 | $189.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.26 / $146.94 / $203.38
| Professional | | $123.26 | $146.94 | $203.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $637.00 / $2,391.00 / $6,000.00
| Facility | | $637.00 | $2,391.00 | $6,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.04 / $214.16 / $334.91
| Professional | | $152.04 | $214.16 | $334.91 |