- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $277.75 / $1,484.39 / $3,363.00
| Facility | | $277.75 | $1,484.39 | $3,363.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.62 / $271.91 / $556.03
| Professional | | $155.62 | $271.91 | $556.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $429.80 / $1,888.98 / $12,000.00
| Facility | | $429.80 | $1,888.98 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.86 / $482.04 / $2,230.64
| Professional | | $228.86 | $482.04 | $2,230.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.98 / $263.39 / $470.22
| Facility | | $204.98 | $263.39 | $470.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.52 / $450.00 / $754.15
| Professional | | $289.52 | $450.00 | $754.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.00 / $500.00 / $3,111.82
| Facility | | $443.00 | $500.00 | $3,111.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.72 / $413.44 / $882.93
| Professional | | $213.72 | $413.44 | $882.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $168.26 / $280.32 / $6,679.00
| Facility | | $168.26 | $280.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.51 / $465.03 / $667.33
| Professional | | $359.51 | $465.03 | $667.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.68 / $479.95 / $909.11
| Professional | | $255.68 | $479.95 | $909.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.01 / $1,763.01 / $4,804.33
| Facility | | $1,763.01 | $1,763.01 | $4,804.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $538.72 / $538.72 / $550.27
| Professional | | $538.72 | $538.72 | $550.27 |
- 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
- $317.89 / $729.26 / $2,230.64
| Professional | | $317.89 | $729.26 | $2,230.64 |
- 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
- $291.27 / $447.45 / $947.32
| Professional | | $291.27 | $447.45 | $947.32 |