- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $348.09 / $2,449.00 / $7,316.00
| Facility | | $348.09 | $2,449.00 | $7,316.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.93 / $300.58 / $446.95
| Professional | | $188.93 | $300.58 | $446.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $271.58 / $482.46 / $1,083.14
| Facility | | $271.58 | $482.46 | $1,083.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.30 / $347.21 / $510.70
| Professional | | $201.30 | $347.21 | $510.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $210.44 / $396.62 / $845.63
| Facility | | $210.44 | $396.62 | $845.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.71 / $208.71 / $417.42
| Professional | | $208.71 | $208.71 | $417.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $193.00 / $193.00 / $378.08
| Facility | | $193.00 | $193.00 | $378.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.87 / $377.80 / $567.49
| Professional | | $235.87 | $377.80 | $567.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,506.90 / $16,394.00 / $16,394.00
| Facility | | $1,506.90 | $16,394.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,594.80 / $2,732.88 / $3,199.58
| Professional | | $1,594.80 | $2,732.88 | $3,199.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.50 / $328.63 / $511.22
| Facility | | $207.50 | $328.63 | $511.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.08 / $428.92 / $685.88
| Professional | | $268.08 | $428.92 | $685.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.64 / $354.51 / $447.37
| Professional | | $201.64 | $354.51 | $447.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.50 / $328.77 / $521.52
| Facility | | $207.50 | $328.77 | $521.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.35 / $392.92 / $654.13
| Professional | | $245.35 | $392.92 | $654.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $161.00 / $952.00 / $2,405.00
| Facility | | $161.00 | $952.00 | $2,405.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.16 / $386.88 / $560.98
| Professional | | $290.16 | $386.88 | $560.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.72 / $354.51 / $496.31
| Professional | | $314.72 | $354.51 | $496.31 |