- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $374.69 / $5,102.00 / $16,210.00
| Facility | | $374.69 | $5,102.00 | $16,210.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.97 / $327.43 / $710.30
| Professional | | $208.97 | $327.43 | $710.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,143.00 / $5,863.00 / $11,400.00
| Facility | | $2,143.00 | $5,863.00 | $11,400.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.53 / $321.58 / $738.71
| Professional | | $202.53 | $321.58 | $738.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.00 / $100.00 / $6,881.37
| Facility | | $66.00 | $100.00 | $6,881.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.78 / $336.44 / $673.69
| Professional | | $210.78 | $336.44 | $673.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.91 / $384.92 / $719.16
| Professional | | $235.91 | $384.92 | $719.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.18 / $319.41 / $574.54
| Professional | | $113.18 | $319.41 | $574.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.05 / $410.79 / $741.34
| Professional | | $245.05 | $410.79 | $741.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,653.96 / $2,000.00 / $16,394.00
| Facility | | $1,653.96 | $2,000.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,741.12 / $2,786.08 / $3,293.03
| Professional | | $1,741.12 | $2,786.08 | $3,293.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $220.53 / $338.08 / $574.54
| Facility | | $220.53 | $338.08 | $574.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.14 / $405.67 / $749.44
| Professional | | $240.14 | $405.67 | $749.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $782.29 / $782.29 / $1,273.97
| Professional | | $782.29 | $782.29 | $1,273.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.13 / $242.64 / $531.89
| Professional | | $147.13 | $242.64 | $531.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $570.00 / $1,533.00 / $5,830.00
| Facility | | $570.00 | $1,533.00 | $5,830.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.64 / $378.17 / $877.65
| Professional | | $291.64 | $378.17 | $877.65 |