- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.77 / $911.82 / $17,930.00
| Facility | | $117.77 | $911.82 | $17,930.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.44 / $190.79 / $911.82
| Professional | | $80.44 | $190.79 | $911.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $411.75 / $411.75 / $942.33
| Facility | | $411.75 | $411.75 | $942.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.48 / $981.77 / $4,646.85
| Professional | | $127.48 | $981.77 | $4,646.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.03 / $271.33 / $1,861.54
| Professional | | $109.03 | $271.33 | $1,861.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $86.18 / $199.42 / $522.87
| Facility | | $86.18 | $199.42 | $522.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.97 / $200.50 / $582.33
| Professional | | $81.97 | $200.50 | $582.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.41 / $1,045.34 / $1,871.17
| Professional | | $183.41 | $1,045.34 | $1,871.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $180.23 / $953.41 / $1,381.54
| Facility | | $180.23 | $953.41 | $1,381.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $942.33 / $942.33 / $972.59
| Facility | | $942.33 | $942.33 | $972.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.19 / $365.85 / $1,722.66
| Professional | | $144.19 | $365.85 | $1,722.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.82 / $294.48 / $1,548.53
| Professional | | $123.82 | $294.48 | $1,548.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,050.00 / $2,446.00 / $36,803.00
| Facility | | $1,050.00 | $2,446.00 | $36,803.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.86 / $860.92 / $2,184.94
| Professional | | $271.86 | $860.92 | $2,184.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.54 / $546.05 / $769.06
| Professional | | $88.54 | $546.05 | $769.06 |