- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $379.00 / $2,070.00 / $7,197.00
| Facility | | $379.00 | $2,070.00 | $7,197.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.31 / $162.12 / $291.22
| Professional | | $122.31 | $162.12 | $291.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,299.82 / $2,746.00 / $13,822.74
| Facility | | $2,299.82 | $2,746.00 | $13,822.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.43 / $255.66 / $326.14
| Professional | | $179.43 | $255.66 | $326.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $224.88 / $224.88 / $224.88
| Facility | | $224.88 | $224.88 | $224.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.10 / $199.40 / $331.00
| Professional | | $143.10 | $199.40 | $331.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.34 / $292.67 / $370.22
| Professional | | $214.34 | $292.67 | $370.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $306.82 / $1,552.05 / $3,586.05
| Facility | | $306.82 | $1,552.05 | $3,586.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $617.00 / $2,326.00 / $8,017.00
| Facility | | $617.00 | $2,326.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.81 / $186.20 / $686.49
| Professional | | $122.81 | $186.20 | $686.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.90 / $189.90 / $373.80
| Professional | | $189.90 | $189.90 | $373.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $224.88 / $224.88 / $224.88
| Facility | | $224.88 | $224.88 | $224.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.10 / $203.12 / $339.17
| Professional | | $143.10 | $203.12 | $339.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.09 / $147.21 / $187.13
| Facility | | $130.09 | $147.21 | $187.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.09 / $171.10 / $188.78
| Professional | | $130.09 | $171.10 | $188.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $471.00 / $1,305.00 / $3,742.00
| Facility | | $471.00 | $1,305.00 | $3,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.52 / $226.31 / $346.14
| Professional | | $168.52 | $226.31 | $346.14 |