- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $217.47 / $2,067.00 / $3,625.00
| Facility | | $217.47 | $2,067.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.36 / $237.59 / $553.63
| Professional | | $193.36 | $237.59 | $553.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.00 / $763.99 / $2,713.00
| Facility | | $308.00 | $763.99 | $2,713.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.20 / $451.96 / $1,775.12
| Professional | | $221.20 | $451.96 | $1,775.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $283.83 / $364.72 / $651.11
| Facility | | $283.83 | $364.72 | $651.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $357.98 / $479.21 / $630.53
| Professional | | $357.98 | $479.21 | $630.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $50.00 / $50.00
| Facility | | $50.00 | $50.00 | $50.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.30 / $394.10 / $666.03
| Professional | | $242.30 | $394.10 | $666.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.32 / $362.28 / $6,679.00
| Facility | | $214.32 | $362.28 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.18 / $349.15 / $482.68
| Professional | | $286.18 | $349.15 | $482.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.77 / $572.16 / $738.62
| Professional | | $288.77 | $572.16 | $738.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $171.64 / $222.63 / $556.52
| Facility | | $171.64 | $222.63 | $556.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.64 / $279.18 / $279.18
| Professional | | $200.64 | $279.18 | $279.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,214.81 / $3,445.00
| Facility | | $55.00 | $1,214.81 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.35 / $475.30 / $1,775.12
| Professional | | $249.35 | $475.30 | $1,775.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $2,733.00
| Facility | | $627.00 | $1,818.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.19 / $377.55 / $762.42
| Professional | | $238.19 | $377.55 | $762.42 |