- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.48 / $2,067.00 / $3,625.00
| Facility | | $229.48 | $2,067.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.33 / $250.16 / $518.40
| Professional | | $159.33 | $250.16 | $518.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $511.25 / $1,878.00 / $7,161.00
| Facility | | $511.25 | $1,878.00 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.97 / $454.58 / $1,520.64
| Professional | | $227.97 | $454.58 | $1,520.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $246.15 / $320.00 / $564.66
| Facility | | $246.15 | $320.00 | $564.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.44 / $441.79 / $739.62
| Professional | | $280.44 | $441.79 | $739.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $50.00 / $50.00
| Facility | | $50.00 | $50.00 | $50.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.55 / $405.45 / $855.19
| Professional | | $235.55 | $405.45 | $855.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.36 / $314.19 / $6,679.00
| Facility | | $208.36 | $314.19 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.46 / $413.99 / $571.47
| Professional | | $328.46 | $413.99 | $571.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.05 / $546.29 / $875.00
| Professional | | $258.05 | $546.29 | $875.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $429.67 / $919.56 / $922.12
| Facility | | $429.67 | $919.56 | $922.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.44 / $314.27 / $455.72
| Professional | | $233.44 | $314.27 | $455.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.00 / $2,078.00 / $11,500.00
| Facility | | $1,106.00 | $2,078.00 | $11,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.41 / $568.03 / $2,138.56
| Professional | | $298.41 | $568.03 | $2,138.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $950.00 / $2,408.00 / $7,161.00
| Facility | | $950.00 | $2,408.00 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.13 / $415.21 / $803.86
| Professional | | $232.13 | $415.21 | $803.86 |