- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $167.68 / $1,790.65 / $3,424.00
| Facility | | $167.68 | $1,790.65 | $3,424.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.56 / $155.72 / $373.48
| Professional | | $81.56 | $155.72 | $373.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $250.22 / $1,689.00 / $12,000.00
| Facility | | $250.22 | $1,689.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.09 / $290.98 / $2,302.71
| Professional | | $120.09 | $290.98 | $2,302.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $92.28 / $118.58 / $211.69
| Facility | | $92.28 | $118.58 | $211.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.57 / $174.25 / $414.65
| Professional | | $38.57 | $174.25 | $414.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.00 / $500.00 / $1,576.60
| Facility | | $443.00 | $500.00 | $1,576.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.20 / $221.61 / $456.00
| Professional | | $108.20 | $221.61 | $456.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $377.00 / $6,679.00
| Facility | | $83.43 | $377.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.50 / $256.80 / $386.39
| Professional | | $199.50 | $256.80 | $386.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.43 / $221.88 / $469.96
| Professional | | $120.43 | $221.88 | $469.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $651.36 / $1,928.58 / $3,441.50
| Facility | | $651.36 | $1,928.58 | $3,441.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.73 / $130.03 / $229.49
| Professional | | $125.73 | $130.03 | $229.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $557.34 / $2,338.00 / $12,000.00
| Facility | | $557.34 | $2,338.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.73 / $518.09 / $2,302.71
| Professional | | $200.73 | $518.09 | $2,302.71 |
- 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
- $182.15 / $277.77 / $643.41
| Professional | | $182.15 | $277.77 | $643.41 |