- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $180.77 / $1,473.20 / $3,363.00
| Facility | | $180.77 | $1,473.20 | $3,363.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.31 / $177.84 / $357.68
| Professional | | $102.31 | $177.84 | $357.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $557.88 / $2,391.00
| Facility | | $75.00 | $557.88 | $2,391.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.04 / $329.24 / $1,476.88
| Professional | | $149.04 | $329.24 | $1,476.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.71 / $169.25 / $302.14
| Facility | | $131.71 | $169.25 | $302.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.53 / $252.32 / $452.89
| Professional | | $122.53 | $252.32 | $452.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $231.08 / $290.93 / $500.00
| Facility | | $231.08 | $290.93 | $500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.54 / $272.87 / $562.25
| Professional | | $138.54 | $272.87 | $562.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.85 / $214.32 / $6,679.00
| Facility | | $110.85 | $214.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.05 / $310.55 / $443.72
| Professional | | $239.05 | $310.55 | $443.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.07 / $304.85 / $567.53
| Professional | | $165.07 | $304.85 | $567.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $195.61 / $404.61 / $4,843.12
| Facility | | $195.61 | $404.61 | $4,843.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.12 / $319.92 / $354.00
| Professional | | $173.12 | $319.92 | $354.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $761.16 / $2,733.00
| Facility | | $55.00 | $761.16 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.90 / $488.82 / $1,476.88
| Professional | | $212.90 | $488.82 | $1,476.88 |
- 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
- $193.03 / $300.02 / $808.83
| Professional | | $193.03 | $300.02 | $808.83 |