- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.95 / $2,266.00 / $7,629.00
| Facility | | $263.95 | $2,266.00 | $7,629.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.13 / $239.19 / $358.96
| Professional | | $196.13 | $239.19 | $358.96 |
- 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
- $240.80 / $249.89 / $440.47
| Professional | | $240.80 | $249.89 | $440.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $358.00 / $358.00 / $358.00
| Facility | | $358.00 | $358.00 | $358.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.73 / $243.24 / $415.54
| Professional | | $181.73 | $243.24 | $415.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.42 / $297.42 / $383.53
| Professional | | $297.42 | $297.42 | $383.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.02 / $242.02 / $293.81
| Professional | | $242.02 | $242.02 | $293.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $617.00 / $2,422.00 / $8,017.00
| Facility | | $617.00 | $2,422.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.89 / $251.08 / $1,279.66
| Professional | | $203.89 | $251.08 | $1,279.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.39 / $307.39 / $307.39
| Professional | | $307.39 | $307.39 | $307.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $358.00 / $358.00 / $358.00
| Facility | | $358.00 | $358.00 | $358.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.57 / $247.11 / $409.73
| Professional | | $180.57 | $247.11 | $409.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.53 / $230.13 / $267.75
| Facility | | $207.53 | $230.13 | $267.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.53 / $230.13 / $267.75
| Professional | | $207.53 | $230.13 | $267.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.00 / $577.00 / $3,742.00
| Facility | | $144.00 | $577.00 | $3,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.78 / $277.37 / $451.67
| Professional | | $210.78 | $277.37 | $451.67 |