- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $369.14 / $3,145.28 / $7,307.00
| Facility | | $369.14 | $3,145.28 | $7,307.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.73 / $346.14 / $674.93
| Professional | | $282.73 | $346.14 | $674.93 |
- 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
- $290.20 / $357.95 / $764.51
| Professional | | $290.20 | $357.95 | $764.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $451.47 / $1,716.00 / $6,213.00
| Facility | | $451.47 | $1,716.00 | $6,213.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $451.47 / $451.47 / $551.26
| Professional | | $451.47 | $451.47 | $551.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.32 / $540.32 / $540.32
| Facility | | $540.32 | $540.32 | $540.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.13 / $469.01 / $1,005.20
| Professional | | $245.13 | $469.01 | $1,005.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $250.00 / $339.55 / $831.33
| Facility | | $250.00 | $339.55 | $831.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $451.83 / $523.71 / $1,103.40
| Professional | | $451.83 | $523.71 | $1,103.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.50 / $360.39 / $711.65
| Professional | | $293.50 | $360.39 | $711.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.32 / $555.00 / $74,999.25
| Facility | | $540.32 | $555.00 | $74,999.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.72 / $489.89 / $1,082.76
| Professional | | $282.72 | $489.89 | $1,082.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,160.00 / $3,963.00 / $8,727.00
| Facility | | $2,160.00 | $3,963.00 | $8,727.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.27 / $446.72 / $958.63
| Professional | | $250.27 | $446.72 | $958.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $341.20 / $341.20 / $1,053.83
| Facility | | $341.20 | $341.20 | $1,053.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.50 / $413.47 / $907.97
| Professional | | $293.50 | $413.47 | $907.97 |