- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.82 / $3,145.28 / $8,442.00
| Facility | | $214.82 | $3,145.28 | $8,442.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.43 / $218.56 / $490.31
| Professional | | $157.43 | $218.56 | $490.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,263.00 / $5,196.00 / $11,909.00
| Facility | | $3,263.00 | $5,196.00 | $11,909.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.80 / $221.28 / $508.97
| Professional | | $170.80 | $221.28 | $508.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $249.53 / $1,716.00 / $6,213.00
| Facility | | $249.53 | $1,716.00 | $6,213.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.53 / $249.53 / $371.28
| Professional | | $249.53 | $249.53 | $371.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $301.91 / $301.91 / $301.91
| Facility | | $301.91 | $301.91 | $301.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.89 / $311.77 / $658.32
| Professional | | $167.89 | $311.77 | $658.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $217.28 / $479.41
| Facility | | $55.00 | $217.28 | $479.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.95 / $358.61 / $763.11
| Professional | | $308.95 | $358.61 | $763.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.02 / $243.58 / $483.30
| Professional | | $186.02 | $243.58 | $483.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,669.29 / $3,669.29 / $3,669.29
| Facility | | $3,669.29 | $3,669.29 | $3,669.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $301.91 / $555.00 / $74,999.25
| Facility | | $301.91 | $555.00 | $74,999.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.15 / $327.14 / $766.85
| Professional | | $179.15 | $327.14 | $766.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,925.00 / $4,840.00 / $9,416.00
| Facility | | $1,925.00 | $4,840.00 | $9,416.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.59 / $304.13 / $660.39
| Professional | | $165.59 | $304.13 | $660.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $191.17 / $191.17 / $620.72
| Facility | | $191.17 | $191.17 | $620.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.02 / $280.79 / $563.12
| Professional | | $186.02 | $280.79 | $563.12 |