- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $918.00 / $2,747.00 / $8,017.00
| Facility | | $918.00 | $2,747.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.13 / $171.18 / $228.15
| Professional | | $155.13 | $171.18 | $228.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,058.35 / $6,182.00 / $17,094.48
| Facility | | $5,058.35 | $6,182.00 | $17,094.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.74 / $185.48 / $185.48
| Professional | | $178.74 | $185.48 | $185.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $203.62 / $203.62 / $203.62
| Facility | | $203.62 | $203.62 | $203.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.43 / $226.99 / $360.69
| Professional | | $162.43 | $226.99 | $360.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.74 / $283.99 / $360.54
| Professional | | $208.74 | $283.99 | $360.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.36 / $207.36 / $207.36
| Professional | | $207.36 | $207.36 | $207.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.00 / $2,679.00 / $8,017.00
| Facility | | $954.00 | $2,679.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.13 / $204.35 / $1,539.00
| Professional | | $155.13 | $204.35 | $1,539.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.50 / $234.50 / $360.50
| Professional | | $234.50 | $234.50 | $360.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $203.62 / $203.62 / $203.62
| Facility | | $203.62 | $203.62 | $203.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.35 / $227.64 / $360.69
| Professional | | $160.35 | $227.64 | $360.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.94 / $175.94 / $182.45
| Facility | | $175.94 | $175.94 | $182.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.19 / $178.20 / $184.74
| Professional | | $169.19 | $178.20 | $184.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.00 / $557.00 / $3,742.00
| Facility | | $226.00 | $557.00 | $3,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.15 / $233.09 / $348.56
| Professional | | $177.15 | $233.09 | $348.56 |