- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $220.22 / $1,473.20 / $3,363.00
| Facility | | $220.22 | $1,473.20 | $3,363.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.52 / $145.79 / $275.00
| Professional | | $103.52 | $145.79 | $275.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $249.97 / $716.81 / $3,445.00
| Facility | | $249.97 | $716.81 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.59 / $185.66 / $744.96
| Professional | | $98.59 | $185.66 | $744.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.91 / $156.94 / $277.37
| Facility | | $120.91 | $156.94 | $277.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.31 / $219.38 / $310.00
| Professional | | $155.31 | $219.38 | $310.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $99.32 / $99.32 / $99.32
| Facility | | $99.32 | $99.32 | $99.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.56 / $209.20 / $385.75
| Professional | | $107.56 | $209.20 | $385.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.02 / $214.32 / $6,679.00
| Facility | | $104.02 | $214.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.41 / $180.54 / $249.22
| Professional | | $143.41 | $180.54 | $249.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.34 / $262.95 / $416.13
| Professional | | $125.34 | $262.95 | $416.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,863.50 / $3,863.50 / $3,863.50
| Facility | | $3,863.50 | $3,863.50 | $3,863.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.36 / $202.26 / $237.35
| Professional | | $177.36 | $202.26 | $237.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $502.00 / $1,818.00 / $11,500.00
| Facility | | $502.00 | $1,818.00 | $11,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.21 / $222.81 / $938.24
| Professional | | $134.21 | $222.81 | $938.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $1,790.00 / $2,733.00
| Facility | | $500.00 | $1,790.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.43 / $170.67 / $370.85
| Professional | | $128.43 | $170.67 | $370.85 |