- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $142.46 / $1,803.00 / $3,625.00
| Facility | | $142.46 | $1,803.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.40 / $126.51 / $287.17
| Professional | | $81.40 | $126.51 | $287.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $271.69 / $1,689.00 / $12,000.00
| Facility | | $271.69 | $1,689.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.77 / $296.10 / $1,801.68
| Professional | | $111.77 | $296.10 | $1,801.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.55 / $129.21 / $256.39
| Facility | | $100.55 | $129.21 | $256.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.10 / $256.93 / $567.44
| Professional | | $128.10 | $256.93 | $567.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.00 / $500.00 / $1,408.94
| Facility | | $443.00 | $500.00 | $1,408.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.51 / $228.05 / $630.89
| Professional | | $113.51 | $228.05 | $630.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.47 / $377.00 / $6,679.00
| Facility | | $87.47 | $377.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.33 / $366.82 / $542.32
| Professional | | $281.33 | $366.82 | $542.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.32 / $308.83 / $685.66
| Professional | | $129.32 | $308.83 | $685.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.76 / $165.76 / $1,859.98
| Facility | | $165.76 | $165.76 | $1,859.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.86 / $134.01 / $267.00
| Professional | | $67.86 | $134.01 | $267.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $593.88 / $2,338.00 / $12,000.00
| Facility | | $593.88 | $2,338.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.87 / $465.30 / $1,801.68
| Professional | | $152.87 | $465.30 | $1,801.68 |
- 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
- $132.41 / $242.84 / $703.58
| Professional | | $132.41 | $242.84 | $703.58 |