- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.43 / $3,697.58 / $8,566.34
| Facility | | $416.43 | $3,697.58 | $8,566.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.42 / $419.71 / $1,041.11
| Professional | | $219.42 | $419.71 | $1,041.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $522.48 / $715.56 / $23,267.55
| Facility | | $522.48 | $715.56 | $23,267.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,450.00 / $5,951.00 / $8,887.00
| Facility | | $2,450.00 | $5,951.00 | $8,887.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.05 / $357.37 / $1,219.23
| Professional | | $345.05 | $357.37 | $1,219.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.54 / $400.51 / $686.65
| Professional | | $237.54 | $400.51 | $686.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.00 / $438.75 / $518.62
| Professional | | $72.00 | $438.75 | $518.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,447.48 / $4,326.97 / $7,715.97
| Facility | | $2,447.48 | $4,326.97 | $7,715.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $480.68 / $728.81 / $7,686.03
| Facility | | $480.68 | $728.81 | $7,686.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $381.44 / $3,867.17 / $8,449.50
| Facility | | $381.44 | $3,867.17 | $8,449.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.62 / $436.21 / $1,007.19
| Professional | | $237.62 | $436.21 | $1,007.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $518.79 / $887.70
| Professional | | $3.00 | $518.79 | $887.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.07 / $391.76 / $745.15
| Professional | | $240.07 | $391.76 | $745.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $222.28 / $323.77 / $605.01
| Facility | | $222.28 | $323.77 | $605.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.25 / $317.62 / $390.47
| Professional | | $222.25 | $317.62 | $390.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,175.00 / $2,824.00 / $4,789.00
| Facility | | $1,175.00 | $2,824.00 | $4,789.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.97 / $464.06 / $754.96
| Professional | | $356.97 | $464.06 | $754.96 |