- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $277.74 / $1,473.20 / $3,363.00
| Facility | | $277.74 | $1,473.20 | $3,363.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.82 / $288.98 / $677.54
| Professional | | $183.82 | $288.98 | $677.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $438.02 / $1,267.00 / $3,472.00
| Facility | | $438.02 | $1,267.00 | $3,472.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.37 / $489.91 / $2,063.52
| Professional | | $215.37 | $489.91 | $2,063.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $233.29 / $299.77 / $534.70
| Facility | | $233.29 | $299.77 | $534.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.92 / $384.15 / $624.77
| Professional | | $100.92 | $384.15 | $624.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $337.40 / $424.80 / $500.00
| Facility | | $337.40 | $424.80 | $500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.35 / $426.22 / $845.10
| Professional | | $222.35 | $426.22 | $845.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $168.26 / $304.56 / $6,679.00
| Facility | | $168.26 | $304.56 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.08 / $429.84 / $616.40
| Professional | | $332.08 | $429.84 | $616.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.68 / $532.63 / $879.38
| Professional | | $284.68 | $532.63 | $879.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.10 / $812.85 / $1,199.33
| Facility | | $158.10 | $812.85 | $1,199.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.62 / $512.79 / $877.91
| Professional | | $303.62 | $512.79 | $877.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $440.00 / $1,340.52 / $3,930.50
| Facility | | $440.00 | $1,340.52 | $3,930.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.65 / $666.60 / $2,063.52
| Professional | | $254.65 | $666.60 | $2,063.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $473.00 / $1,878.00 / $4,142.00
| Facility | | $473.00 | $1,878.00 | $4,142.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.07 / $401.81 / $1,042.43
| Professional | | $234.07 | $401.81 | $1,042.43 |