- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $176.30 / $1,411.87 / $3,103.52
| Facility | | $176.30 | $1,411.87 | $3,103.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.01 / $166.77 / $457.52
| Professional | | $104.01 | $166.77 | $457.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.64 / $941.10 / $11,500.00
| Facility | | $257.64 | $941.10 | $11,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.04 / $297.61 / $1,342.00
| Professional | | $147.04 | $297.61 | $1,342.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.69 / $165.38 / $294.98
| Facility | | $128.69 | $165.38 | $294.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.73 / $227.66 / $441.20
| Professional | | $119.73 | $227.66 | $441.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.18 / $287.27 / $500.00
| Facility | | $228.18 | $287.27 | $500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.24 / $260.89 / $510.46
| Professional | | $138.24 | $260.89 | $510.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.32 / $214.32 / $6,679.00
| Facility | | $108.32 | $214.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.05 / $280.19 / $401.04
| Professional | | $216.05 | $280.19 | $401.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.57 / $295.77 / $507.17
| Professional | | $157.57 | $295.77 | $507.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $650.45 / $650.45 / $650.45
| Facility | | $650.45 | $650.45 | $650.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.99 / $331.38 / $627.94
| Professional | | $313.99 | $331.38 | $627.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.00 / $1,078.00 / $11,500.00
| Facility | | $308.00 | $1,078.00 | $11,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.22 / $447.88 / $1,342.00
| Professional | | $204.22 | $447.88 | $1,342.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.00 / $1,078.00 / $2,733.00
| Facility | | $308.00 | $1,078.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.45 / $274.39 / $617.01
| Professional | | $180.45 | $274.39 | $617.01 |