- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $276.57 / $1,597.64 / $3,363.00
| Facility | | $276.57 | $1,597.64 | $3,363.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.64 / $181.35 / $324.38
| Professional | | $75.64 | $181.35 | $324.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.16 / $1,550.33 / $12,000.00
| Facility | | $229.16 | $1,550.33 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.06 / $350.97 / $1,907.03
| Professional | | $125.06 | $350.97 | $1,907.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $127.31 / $163.59 / $292.05
| Facility | | $127.31 | $163.59 | $292.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.43 / $227.76 / $530.16
| Professional | | $47.43 | $227.76 | $530.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.00 / $500.00 / $1,089.54
| Facility | | $443.00 | $500.00 | $1,089.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.26 / $269.61 / $602.58
| Professional | | $110.26 | $269.61 | $602.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $377.00 / $6,679.00
| Facility | | $83.43 | $377.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.48 / $326.89 / $565.89
| Professional | | $250.48 | $326.89 | $565.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.10 / $264.19 / $586.53
| Professional | | $107.10 | $264.19 | $586.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $569.16 / $1,094.40 / $2,163.80
| Facility | | $569.16 | $1,094.40 | $2,163.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.53 / $216.68 / $332.00
| Professional | | $87.53 | $216.68 | $332.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $444.77 / $2,338.00 / $12,000.00
| Facility | | $444.77 | $2,338.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.42 / $545.73 / $1,907.03
| Professional | | $240.42 | $545.73 | $1,907.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $669.00 / $2,338.00 / $4,952.00
| Facility | | $669.00 | $2,338.00 | $4,952.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.56 / $363.39 / $863.68
| Professional | | $224.56 | $363.39 | $863.68 |