- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $433.71 / $1,823.00 / $3,363.00
| Facility | | $433.71 | $1,823.00 | $3,363.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.99 / $249.08 / $516.35
| Professional | | $154.99 | $249.08 | $516.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $472.60 / $1,251.81 / $7,161.00
| Facility | | $472.60 | $1,251.81 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.30 / $428.82 / $1,407.04
| Professional | | $206.30 | $428.82 | $1,407.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.01 / $296.41 / $523.04
| Facility | | $228.01 | $296.41 | $523.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.98 / $470.85 / $699.29
| Professional | | $287.98 | $470.85 | $699.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.26 / $382.64 / $806.26
| Professional | | $217.26 | $382.64 | $806.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $192.81 / $304.56 / $6,679.00
| Facility | | $192.81 | $304.56 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.14 / $391.41 / $540.29
| Professional | | $310.14 | $391.41 | $540.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.39 / $504.67 / $824.81
| Professional | | $238.39 | $504.67 | $824.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.79 / $824.82 / $5,023.87
| Facility | | $144.79 | $824.82 | $5,023.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.25 / $231.36 / $580.91
| Professional | | $199.25 | $231.36 | $580.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $975.51 / $2,078.00 / $11,500.00
| Facility | | $975.51 | $2,078.00 | $11,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.20 / $536.64 / $2,017.84
| Professional | | $265.20 | $536.64 | $2,017.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.63 / $293.75 / $591.71
| Professional | | $232.63 | $293.75 | $591.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.00 / $2,408.00 / $5,683.00
| Facility | | $1,106.00 | $2,408.00 | $5,683.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.30 / $377.56 / $727.54
| Professional | | $206.30 | $377.56 | $727.54 |