- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.73 / $1,932.00 / $3,469.00
| Facility | | $380.73 | $1,932.00 | $3,469.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.36 / $391.61 / $960.06
| Professional | | $131.36 | $391.61 | $960.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.97 / $2,155.00 / $6,652.46
| Facility | | $141.97 | $2,155.00 | $6,652.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.07 / $1,151.30 / $4,072.05
| Professional | | $180.07 | $1,151.30 | $4,072.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.41 / $189.43 / $375.92
| Facility | | $147.41 | $189.43 | $375.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.41 / $643.30 / $1,510.65
| Professional | | $147.41 | $643.30 | $1,510.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $748.00 / $3,751.11
| Facility | | $680.00 | $748.00 | $3,751.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.57 / $447.37 / $1,827.57
| Professional | | $178.57 | $447.37 | $1,827.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $127.05 / $214.32 / $6,679.00
| Facility | | $127.05 | $214.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $710.91 / $930.84 / $1,606.13
| Professional | | $710.91 | $930.84 | $1,606.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.50 / $634.70 / $1,653.94
| Professional | | $191.50 | $634.70 | $1,653.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,392.67 / $2,392.67 / $2,392.67
| Facility | | $2,392.67 | $2,392.67 | $2,392.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.56 / $205.79 / $393.11
| Professional | | $196.56 | $205.79 | $393.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,238.00 / $6,425.00
| Facility | | $55.00 | $2,238.00 | $6,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $837.01 / $1,583.22 / $4,370.47
| Professional | | $837.01 | $1,583.22 | $4,370.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $4,749.26 / $9,401.00
| Facility | | $1,485.00 | $4,749.26 | $9,401.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $749.79 / $1,271.63 / $2,511.03
| Professional | | $749.79 | $1,271.63 | $2,511.03 |