- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.00 / $1,886.00 / $3,363.00
| Facility | | $537.00 | $1,886.00 | $3,363.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.87 / $464.55 / $985.02
| Professional | | $167.87 | $464.55 | $985.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $447.19 / $2,410.09 / $12,000.00
| Facility | | $447.19 | $2,410.09 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.95 / $840.55 / $3,961.52
| Professional | | $273.95 | $840.55 | $3,961.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $215.20 / $276.52 / $548.76
| Facility | | $215.20 | $276.52 | $548.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.41 / $683.63 / $1,227.05
| Professional | | $280.41 | $683.63 | $1,227.05 |
- 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
- $228.94 / $561.65 / $1,490.40
| Professional | | $228.94 | $561.65 | $1,490.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.10 / $392.40 / $6,679.00
| Facility | | $186.10 | $392.40 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $643.74 / $841.41 / $1,207.07
| Professional | | $643.74 | $841.41 | $1,207.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.44 / $678.71 / $1,506.80
| Professional | | $273.44 | $678.71 | $1,506.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,928.58 / $1,928.58 / $1,928.58
| Facility | | $1,928.58 | $1,928.58 | $1,928.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.50 / $265.50 / $265.50
| Professional | | $265.50 | $265.50 | $265.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $2,854.00 / $12,000.00
| Facility | | $1,061.00 | $2,854.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $555.05 / $1,331.17 / $3,961.52
| Professional | | $555.05 | $1,331.17 | $3,961.52 |
- 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
- $520.33 / $817.23 / $2,146.09
| Professional | | $520.33 | $817.23 | $2,146.09 |