- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $487.00 / $2,166.00 / $7,513.00
| Facility | | $487.00 | $2,166.00 | $7,513.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.14 / $268.68 / $393.34
| Professional | | $242.14 | $268.68 | $393.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,063.71 / $7,513.84 / $14,294.68
| Facility | | $4,063.71 | $7,513.84 | $14,294.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.47 / $285.94 / $411.34
| Professional | | $234.47 | $285.94 | $411.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.60 / $225.60 / $228.69
| Facility | | $225.60 | $225.60 | $228.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,500.00 / $3,517.88 / $4,567.17
| Facility | | $2,500.00 | $3,517.88 | $4,567.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.82 / $352.00 / $543.66
| Professional | | $267.82 | $352.00 | $543.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $15,338.55
| Facility | | $55.00 | $55.00 | $15,338.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,872.16 / $1,924.16 / $2,131.13
| Professional | | $1,872.16 | $1,924.16 | $2,131.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $243.84 / $286.42 / $585.25
| Facility | | $243.84 | $286.42 | $585.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.80 / $381.57 / $463.87
| Professional | | $286.80 | $381.57 | $463.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.98 / $298.55 / $498.86
| Professional | | $230.98 | $298.55 | $498.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.33 / $292.79 / $658.16
| Facility | | $244.33 | $292.79 | $658.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.99 / $367.69 / $642.75
| Professional | | $271.99 | $367.69 | $642.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.00 / $2,054.00 / $4,739.00
| Facility | | $597.00 | $2,054.00 | $4,739.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.27 / $292.95 / $458.37
| Professional | | $218.27 | $292.95 | $458.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.85 / $249.16 / $336.73
| Professional | | $212.85 | $249.16 | $336.73 |