- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.70 / $2,015.00 / $6,554.18
| Facility | | $226.70 | $2,015.00 | $6,554.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.50 / $194.98 / $463.99
| Professional | | $132.50 | $194.98 | $463.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.62 / $94.62 / $104.31
| Professional | | $94.62 | $94.62 | $104.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.00 / $4,354.00 / $8,459.92
| Facility | | $1,350.00 | $4,354.00 | $8,459.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.44 / $228.76 / $228.76
| Professional | | $220.44 | $228.76 | $228.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.32 / $214.17 / $380.32
| Professional | | $145.32 | $214.17 | $380.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.86 / $343.10 / $354.54
| Professional | | $266.86 | $343.10 | $354.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,157.01 / $3,676.25 / $7,262.42
| Facility | | $1,157.01 | $3,676.25 | $7,262.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.29 / $219.68 / $237.19
| Professional | | $158.29 | $219.68 | $237.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $235.22 / $2,046.27 / $6,459.31
| Facility | | $235.22 | $2,046.27 | $6,459.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.41 / $210.00 / $446.63
| Professional | | $141.41 | $210.00 | $446.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.44 / $220.20 / $325.16
| Professional | | $158.44 | $220.20 | $325.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $278.76 / $278.76 / $278.76
| Facility | | $278.76 | $278.76 | $278.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.94 / $218.36 / $395.97
| Professional | | $151.94 | $218.36 | $395.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.77 / $159.71 / $217.57
| Facility | | $143.77 | $159.71 | $217.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.44 / $190.93 / $233.36
| Professional | | $155.44 | $190.93 | $233.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $637.00 / $2,391.00 / $6,000.00
| Facility | | $637.00 | $2,391.00 | $6,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.45 / $230.45 / $425.86
| Professional | | $179.45 | $230.45 | $425.86 |