- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $480.00 / $2,467.00 / $8,017.00
| Facility | | $480.00 | $2,467.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.22 / $240.74 / $376.73
| Professional | | $144.22 | $240.74 | $376.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,404.00 / $4,354.00 / $8,639.91
| Facility | | $2,404.00 | $4,354.00 | $8,639.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.63 / $267.36 / $267.36
| Professional | | $257.63 | $267.36 | $267.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $261.94 / $261.94 / $261.94
| Facility | | $261.94 | $261.94 | $261.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.50 / $253.20 / $444.95
| Professional | | $153.50 | $253.20 | $444.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.69 / $414.16 / $534.92
| Professional | | $309.69 | $414.16 | $534.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,818.09 / $3,498.17 / $9,353.75
| Facility | | $1,818.09 | $3,498.17 | $9,353.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $641.00 / $2,483.00 / $8,017.00
| Facility | | $641.00 | $2,483.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.13 / $261.11 / $823.89
| Professional | | $148.13 | $261.11 | $823.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.20 / $183.20 / $568.90
| Professional | | $183.20 | $183.20 | $568.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $261.94 / $261.94 / $261.94
| Facility | | $261.94 | $261.94 | $261.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.44 / $256.01 / $466.44
| Professional | | $158.44 | $256.01 | $466.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $152.16 / $175.40 / $258.70
| Facility | | $152.16 | $175.40 | $258.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.15 / $228.24 / $278.61
| Professional | | $152.15 | $228.24 | $278.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $814.00 / $2,391.00 / $4,789.00
| Facility | | $814.00 | $2,391.00 | $4,789.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.22 / $310.38 / $510.67
| Professional | | $215.22 | $310.38 | $510.67 |