- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $2,818.38 / $9,332.54
| Facility | | $263.03 | $2,818.38 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $309.03 / $676.08
| Professional | | $177.83 | $309.03 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $3,630.78 / $5,011.87
| Facility | | $1,819.70 | $3,630.78 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $338.84 / $794.33
| Professional | | $275.42 | $338.84 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $269.15 / $6,165.95
| Facility | | $269.15 | $269.15 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $269.15 / $478.63
| Professional | | $269.15 | $269.15 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $338.84 / $50,118.72
| Facility | | $34.67 | $338.84 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $436.52 / $1,230.27
| Professional | | $213.80 | $436.52 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $323.59 / $831.76
| Facility | | $257.04 | $323.59 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $741.31 / $1,096.48
| Professional | | $549.54 | $741.31 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $346.74 / $346.74
| Facility | | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $478.63 / $758.58
| Professional | | $251.19 | $478.63 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $50,118.72 / $75,857.76
| Facility | | $173.78 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $467.74 / $1,000.00
| Professional | | $398.11 | $467.74 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,754.23 / $4,897.79
| Facility | | $831.76 | $2,754.23 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $331.13 / $870.96
| Professional | | $177.83 | $331.13 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $234.42 / $776.25
| Facility | | $158.49 | $234.42 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $436.52 / $851.14
| Professional | | $257.04 | $436.52 | $851.14 |