- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $362.72 / $1,598.19 / $7,175.00
| Facility | | $362.72 | $1,598.19 | $7,175.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.25 / $338.65 / $650.90
| Professional | | $208.25 | $338.65 | $650.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,083.51 / $1,395.00 / $12,759.45
| Facility | | $1,083.51 | $1,395.00 | $12,759.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $379.96 / $394.30 / $394.30
| Professional | | $379.96 | $394.30 | $394.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.87 / $363.81 / $587.99
| Professional | | $231.87 | $363.81 | $587.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.02 / $592.74 / $612.78
| Professional | | $461.02 | $592.74 | $612.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $752.00 / $1,193.74 / $2,944.24
| Facility | | $752.00 | $1,193.74 | $2,944.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.57 / $352.57 / $372.96
| Professional | | $352.57 | $352.57 | $372.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $381.09 / $1,742.50 / $7,693.75
| Facility | | $381.09 | $1,742.50 | $7,693.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.62 / $361.42 / $776.22
| Professional | | $210.62 | $361.42 | $776.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.10 / $289.10 / $304.00
| Professional | | $289.10 | $289.10 | $304.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $408.00 / $408.00 / $408.00
| Facility | | $408.00 | $408.00 | $408.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.47 / $368.78 / $609.88
| Professional | | $238.47 | $368.78 | $609.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.37 / $240.07 / $377.59
| Facility | | $234.37 | $240.07 | $377.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.37 / $369.26 / $405.53
| Professional | | $234.37 | $369.26 | $405.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.00 / $674.00 / $4,300.00
| Facility | | $144.00 | $674.00 | $4,300.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.43 / $427.17 / $741.63
| Professional | | $320.43 | $427.17 | $741.63 |