- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $419.77 / $2,872.00 / $10,048.00
| Facility | | $419.77 | $2,872.00 | $10,048.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.49 / $305.45 / $490.46
| Professional | | $168.49 | $305.45 | $490.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $182.50 / $318.31 / $1,298.73
| Facility | | $182.50 | $318.31 | $1,298.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.06 / $296.37 / $525.09
| Professional | | $168.06 | $296.37 | $525.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.97 / $158.97 / $158.97
| Facility | | $158.97 | $158.97 | $158.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.91 / $293.91 / $293.91
| Facility | | $293.91 | $293.91 | $293.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.69 / $368.12 / $608.00
| Professional | | $198.69 | $368.12 | $608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $883.98
| Facility | | $55.00 | $55.00 | $883.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,164.00 / $2,470.64 / $2,909.78
| Professional | | $2,164.00 | $2,470.64 | $2,909.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $191.24 / $355.84 / $671.39
| Facility | | $191.24 | $355.84 | $671.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.28 / $367.91 / $602.03
| Professional | | $231.28 | $367.91 | $602.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.68 / $376.33 / $427.54
| Professional | | $190.68 | $376.33 | $427.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $191.24 / $359.14 / $696.58
| Facility | | $191.24 | $359.14 | $696.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.72 / $379.31 / $615.34
| Professional | | $201.72 | $379.31 | $615.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,154.00 / $3,314.00 / $7,600.00
| Facility | | $1,154.00 | $3,314.00 | $7,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.35 / $373.25 / $604.32
| Professional | | $268.35 | $373.25 | $604.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.45 / $321.95 / $451.99
| Professional | | $285.45 | $321.95 | $451.99 |