- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $242.09 / $1,473.20 / $3,905.50
| Facility | | $242.09 | $1,473.20 | $3,905.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.88 / $245.75 / $562.21
| Professional | | $127.88 | $245.75 | $562.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $438.00 / $2,410.09 / $12,000.00
| Facility | | $438.00 | $2,410.09 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.47 / $468.81 / $2,216.71
| Professional | | $198.47 | $468.81 | $2,216.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $164.00 / $210.74 / $380.59
| Facility | | $164.00 | $210.74 | $380.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.26 / $380.59 / $683.12
| Professional | | $209.26 | $380.59 | $683.12 |
- 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
- $172.23 / $381.03 / $819.18
| Professional | | $172.23 | $381.03 | $819.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.11 / $377.00 / $6,679.00
| Facility | | $141.11 | $377.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.59 / $468.42 / $667.48
| Professional | | $359.59 | $468.42 | $667.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.30 / $390.45 / $845.70
| Professional | | $207.30 | $390.45 | $845.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,641.41 / $4,436.96 / $5,321.49
| Facility | | $1,641.41 | $4,436.96 | $5,321.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.98 / $224.05 / $433.47
| Professional | | $105.98 | $224.05 | $433.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $951.36 / $2,854.00 / $12,000.00
| Facility | | $951.36 | $2,854.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.79 / $739.81 / $2,216.71
| Professional | | $302.79 | $739.81 | $2,216.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $3,715.00 / $8,452.40
| Facility | | $1,061.00 | $3,715.00 | $8,452.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.63 / $455.75 / $1,381.96
| Professional | | $281.63 | $455.75 | $1,381.96 |