- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.20 / $2,240.00 / $7,629.00
| Facility | | $294.20 | $2,240.00 | $7,629.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.74 / $255.08 / $432.32
| Professional | | $184.74 | $255.08 | $432.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,299.82 / $2,746.00 / $13,822.74
| Facility | | $2,299.82 | $2,746.00 | $13,822.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.97 / $285.35 / $513.64
| Professional | | $274.97 | $285.35 | $513.64 |
- 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
- $186.61 / $272.38 / $424.99
| Professional | | $186.61 | $272.38 | $424.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.24 / $332.24 / $428.43
| Professional | | $332.24 | $332.24 | $428.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.42 / $327.00 / $416.36
| Professional | | $318.42 | $327.00 | $416.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $594.00 / $2,371.00 / $8,017.00
| Facility | | $594.00 | $2,371.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.88 / $270.99 / $705.86
| Professional | | $201.88 | $270.99 | $705.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $394.90 / $394.90 / $394.90
| Professional | | $394.90 | $394.90 | $394.90 |
- 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
- $185.79 / $272.04 / $407.39
| Professional | | $185.79 | $272.04 | $407.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $200.77 / $262.11 / $387.53
| Facility | | $200.77 | $262.11 | $387.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.45 / $260.39 / $387.53
| Professional | | $200.45 | $260.39 | $387.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $412.00 / $1,219.00 / $4,300.00
| Facility | | $412.00 | $1,219.00 | $4,300.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.54 / $332.69 / $526.76
| Professional | | $258.54 | $332.69 | $526.76 |