- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $485.94 / $1,885.00 / $3,625.00
| Facility | | $485.94 | $1,885.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.45 / $215.98 / $617.37
| Professional | | $117.45 | $215.98 | $617.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $266.64 / $840.38 / $2,733.00
| Facility | | $266.64 | $840.38 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.46 / $325.18 / $1,793.11
| Professional | | $152.46 | $325.18 | $1,793.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.29 / $182.38 / $321.83
| Facility | | $140.29 | $182.38 | $321.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.08 / $224.93 / $388.85
| Professional | | $133.08 | $224.93 | $388.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.34 / $332.21 / $632.23
| Professional | | $191.34 | $332.21 | $632.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $121.46 / $300.00 / $6,679.00
| Facility | | $121.46 | $300.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.42 / $286.11 / $511.55
| Professional | | $226.42 | $286.11 | $511.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.57 / $326.47 / $561.66
| Professional | | $151.57 | $326.47 | $561.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $722.22 / $758.40 / $992.51
| Facility | | $722.22 | $758.40 | $992.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.24 / $339.78 / $363.38
| Professional | | $288.24 | $339.78 | $363.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,078.00 / $3,445.00
| Facility | | $55.00 | $1,078.00 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.45 / $492.70 / $1,793.11
| Professional | | $259.45 | $492.70 | $1,793.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.33 / $546.32 / $751.65
| Facility | | $89.33 | $546.32 | $751.65 |
- 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
- $241.25 / $315.22 / $629.13
| Professional | | $241.25 | $315.22 | $629.13 |