- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $312.50 / $1,319.00 / $3,363.00
| Facility | | $312.50 | $1,319.00 | $3,363.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.40 / $458.20 / $1,398.41
| Professional | | $171.40 | $458.20 | $1,398.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.00 / $932.33 / $2,733.00
| Facility | | $308.00 | $932.33 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.36 / $514.29 / $1,551.52
| Professional | | $208.36 | $514.29 | $1,551.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.04 / $283.45 / $556.00
| Facility | | $218.04 | $283.45 | $556.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.88 / $541.17 / $1,043.71
| Professional | | $295.88 | $541.17 | $1,043.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.71 / $487.98 / $1,103.78
| Professional | | $211.71 | $487.98 | $1,103.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $300.00 / $8,090.00
| Facility | | $186.21 | $300.00 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $459.85 / $582.61 / $806.43
| Professional | | $459.85 | $582.61 | $806.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.42 / $505.86 / $1,116.43
| Professional | | $231.42 | $505.86 | $1,116.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $507.02 / $1,182.97 / $1,838.52
| Facility | | $507.02 | $1,182.97 | $1,838.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $481.76 / $666.79 / $2,496.90
| Professional | | $481.76 | $666.79 | $2,496.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $966.90 / $3,445.00
| Facility | | $55.00 | $966.90 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.34 / $734.16 / $2,973.60
| Professional | | $436.34 | $734.16 | $2,973.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.67 / $432.42 / $886.51
| Professional | | $341.67 | $432.42 | $886.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $2,733.00
| Facility | | $627.00 | $1,818.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.37 / $558.20 / $1,137.41
| Professional | | $376.37 | $558.20 | $1,137.41 |