- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $569.00 / $2,514.00 / $7,495.00
| Facility | | $569.00 | $2,514.00 | $7,495.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $342.31 / $514.09 / $785.67
| Professional | | $342.31 | $514.09 | $785.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $287.56 / $511.22 / $1,140.65
| Facility | | $287.56 | $511.22 | $1,140.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $386.75 / $599.36 / $996.04
| Professional | | $386.75 | $599.36 | $996.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $373.08 / $373.08 / $626.97
| Facility | | $373.08 | $373.08 | $626.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.17 / $635.16 / $922.85
| Professional | | $438.17 | $635.16 | $922.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,876.40 / $16,394.00 / $16,394.00
| Facility | | $2,876.40 | $16,394.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,025.68 / $4,321.20 / $5,113.35
| Professional | | $3,025.68 | $4,321.20 | $5,113.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $392.99 / $561.42 / $825.70
| Facility | | $392.99 | $561.42 | $825.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.50 / $764.09 / $1,090.78
| Professional | | $513.50 | $764.09 | $1,090.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $392.99 / $561.42 / $833.83
| Facility | | $392.99 | $561.42 | $833.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.18 / $665.40 / $1,071.85
| Professional | | $450.18 | $665.40 | $1,071.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $161.00 / $1,058.00 / $2,667.00
| Facility | | $161.00 | $1,058.00 | $2,667.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.04 / $626.88 / $908.98
| Professional | | $460.04 | $626.88 | $908.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.51 / $500.51 / $790.26
| Professional | | $500.51 | $500.51 | $790.26 |