- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $3,890.45 / $10,232.93
| Facility | | $263.03 | $3,890.45 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $204.17 / $588.84
| Professional | | $154.88 | $204.17 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $4,786.30 / $10,000.00
| Facility | | $2,630.27 | $4,786.30 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $173.78 / $416.87
| Professional | | $134.90 | $173.78 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $1,698.24 / $6,165.95
| Facility | | $257.04 | $1,698.24 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $257.04 / $257.04
| Professional | | $257.04 | $257.04 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $302.00 / $50,118.72
| Facility | | $302.00 | $302.00 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $281.84 / $870.96
| Professional | | $173.78 | $281.84 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $229.09 / $602.56
| Facility | | $186.21 | $229.09 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $245.47 / $354.81
| Professional | | $177.83 | $245.47 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $165.96 / $165.96
| Facility | | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $229.09 / $371.54
| Professional | | $141.25 | $229.09 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $50,118.72 / $75,857.76
| Facility | | $194.98 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $331.13 / $524.81
| Professional | | $218.78 | $331.13 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,754.23 / $4,897.79
| Facility | | $1,258.93 | $2,754.23 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $239.88 / $588.84
| Professional | | $151.36 | $239.88 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $204.17 / $758.58
| Facility | | $144.54 | $204.17 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $208.93 / $446.68
| Professional | | $144.54 | $208.93 | $446.68 |