- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $201.22 / $2,240.00 / $7,629.00
| Facility | | $201.22 | $2,240.00 | $7,629.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.02 / $155.37 / $237.72
| Professional | | $92.02 | $155.37 | $237.72 |
- 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
- $170.87 / $177.32 / $303.52
| Professional | | $170.87 | $177.32 | $303.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.00 / $549.00 / $549.00
| Facility | | $549.00 | $549.00 | $549.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.97 / $157.88 / $265.19
| Professional | | $84.97 | $157.88 | $265.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.49 / $211.49 / $272.72
| Professional | | $211.49 | $211.49 | $272.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.23 / $217.32 / $217.32
| Professional | | $216.23 | $217.32 | $217.32 |
- 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
- $92.06 / $175.71 / $800.00
| Professional | | $92.06 | $175.71 | $800.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.06 / $268.20 / $286.89
| Professional | | $212.06 | $268.20 | $286.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.00 / $549.00 / $549.00
| Facility | | $549.00 | $549.00 | $549.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.16 / $156.72 / $239.07
| Professional | | $86.16 | $156.72 | $239.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.49 / $118.81 / $328.38
| Facility | | $91.49 | $118.81 | $328.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.12 / $170.71 / $328.38
| Professional | | $91.12 | $170.71 | $328.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $582.00 / $3,218.09 / $7,508.87
| Facility | | $582.00 | $3,218.09 | $7,508.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.13 / $200.52 / $341.62
| Professional | | $148.13 | $200.52 | $341.62 |