- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $485.62 / $1,411.87 / $3,363.00
| Facility | | $485.62 | $1,411.87 | $3,363.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.51 / $199.95 / $531.90
| Professional | | $111.51 | $199.95 | $531.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.78 / $640.30 / $2,713.00
| Facility | | $251.78 | $640.30 | $2,713.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.22 / $263.60 / $1,161.28
| Professional | | $123.22 | $263.60 | $1,161.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $124.27 / $161.55 / $285.08
| Facility | | $124.27 | $161.55 | $285.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.01 / $244.35 / $398.31
| Professional | | $148.01 | $244.35 | $398.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.54 / $270.43 / $494.41
| Professional | | $152.54 | $270.43 | $494.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.61 / $214.32 / $6,679.00
| Facility | | $108.61 | $214.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.33 / $184.80 / $297.94
| Professional | | $100.33 | $184.80 | $297.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.29 / $295.61 / $441.96
| Professional | | $137.29 | $295.61 | $441.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $362.48 / $605.46 / $718.44
| Facility | | $362.48 | $605.46 | $718.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.13 / $292.45 / $369.00
| Professional | | $140.13 | $292.45 | $369.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,078.00 / $3,445.00
| Facility | | $55.00 | $1,078.00 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.40 / $401.85 / $1,161.28
| Professional | | $192.40 | $401.85 | $1,161.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $3,445.00
| Facility | | $627.00 | $1,818.00 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.48 / $247.43 / $492.22
| Professional | | $179.48 | $247.43 | $492.22 |