- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $262.82 / $3,205.00 / $7,343.00
| Facility | | $262.82 | $3,205.00 | $7,343.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.93 / $399.90 / $662.34
| Professional | | $173.93 | $399.90 | $662.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,393.00 / $4,120.00 / $8,836.00
| Facility | | $2,393.00 | $4,120.00 | $8,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.97 / $362.80 / $956.83
| Professional | | $281.97 | $362.80 | $956.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.11 / $228.11 / $6,213.00
| Facility | | $228.11 | $228.11 | $6,213.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.11 / $228.11 / $552.29
| Professional | | $228.11 | $228.11 | $552.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.01 / $275.01 / $3,479.91
| Facility | | $275.01 | $275.01 | $3,479.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.27 / $474.81 / $1,339.96
| Professional | | $184.27 | $474.81 | $1,339.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.56 / $275.63 / $468.83
| Facility | | $169.56 | $275.63 | $468.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.72 / $402.37 / $696.10
| Professional | | $173.72 | $402.37 | $696.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.72 / $420.07 / $670.88
| Professional | | $301.72 | $420.07 | $670.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,693.68 / $2,693.68 / $2,693.68
| Facility | | $2,693.68 | $2,693.68 | $2,693.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.01 / $597.00 / $8,498.00
| Facility | | $275.01 | $597.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.09 / $517.07 / $1,318.94
| Professional | | $224.09 | $517.07 | $1,318.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,625.00 / $3,511.00 / $6,179.82
| Facility | | $1,625.00 | $3,511.00 | $6,179.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.14 / $486.58 / $1,397.38
| Professional | | $333.14 | $486.58 | $1,397.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.97 / $207.97 / $569.09
| Facility | | $207.97 | $207.97 | $569.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.72 / $479.20 / $744.65
| Professional | | $301.72 | $479.20 | $744.65 |