- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $480.00 / $2,505.00 / $9,534.00
| Facility | | $480.00 | $2,505.00 | $9,534.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.04 / $225.82 / $342.63
| Professional | | $148.04 | $225.82 | $342.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,299.82 / $2,746.00 / $13,822.74
| Facility | | $2,299.82 | $2,746.00 | $13,822.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.92 / $252.09 / $388.81
| Professional | | $242.92 | $252.09 | $388.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.31 / $270.31 / $270.31
| Facility | | $270.31 | $270.31 | $270.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.74 / $249.30 / $435.01
| Professional | | $160.74 | $249.30 | $435.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.27 / $387.33 / $501.39
| Professional | | $290.27 | $387.33 | $501.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,766.12 / $1,766.12 / $1,766.12
| Facility | | $1,766.12 | $1,766.12 | $1,766.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $641.00 / $2,483.00 / $8,451.00
| Facility | | $641.00 | $2,483.00 | $8,451.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.91 / $252.30 / $847.30
| Professional | | $155.91 | $252.30 | $847.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.50 / $266.20 / $529.20
| Professional | | $228.50 | $266.20 | $529.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.31 / $270.31 / $270.31
| Facility | | $270.31 | $270.31 | $270.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.97 / $251.66 / $447.44
| Professional | | $161.97 | $251.66 | $447.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.41 / $191.43 / $259.10
| Facility | | $157.41 | $191.43 | $259.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.41 / $240.82 / $263.18
| Professional | | $157.41 | $240.82 | $263.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $471.00 / $1,305.00 / $3,742.00
| Facility | | $471.00 | $1,305.00 | $3,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.78 / $282.45 / $459.97
| Professional | | $208.78 | $282.45 | $459.97 |