- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $212.59 / $1,803.00 / $3,622.25
| Facility | | $212.59 | $1,803.00 | $3,622.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.21 / $204.42 / $481.04
| Professional | | $112.21 | $204.42 | $481.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $394.67 / $1,689.00 / $12,000.00
| Facility | | $394.67 | $1,689.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.06 / $370.11 / $1,781.92
| Professional | | $160.06 | $370.11 | $1,781.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $145.16 / $186.53 / $333.00
| Facility | | $145.16 | $186.53 | $333.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.39 / $266.14 / $559.67
| Professional | | $123.39 | $266.14 | $559.67 |
- 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
- $146.60 / $313.08 / $652.15
| Professional | | $146.60 | $313.08 | $652.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $124.65 / $377.00 / $6,679.00
| Facility | | $124.65 | $377.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.70 / $375.72 / $535.89
| Professional | | $288.70 | $375.72 | $535.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.62 / $336.46 / $679.28
| Professional | | $182.62 | $336.46 | $679.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $362.09 / $1,913.07 / $4,436.96
| Facility | | $362.09 | $1,913.07 | $4,436.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.73 / $387.25 / $463.60
| Professional | | $197.73 | $387.25 | $463.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $2,338.00 / $12,000.00
| Facility | | $822.00 | $2,338.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.20 / $591.40 / $1,781.92
| Professional | | $217.20 | $591.40 | $1,781.92 |
- 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
- $180.89 / $333.45 / $979.19
| Professional | | $180.89 | $333.45 | $979.19 |