- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $279.93 / $2,079.00 / $3,625.00
| Facility | | $279.93 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.34 / $264.01 / $494.38
| Professional | | $117.34 | $264.01 | $494.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $262.38 / $716.81 / $2,713.00
| Facility | | $262.38 | $716.81 | $2,713.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.93 / $336.75 / $1,024.40
| Professional | | $129.93 | $336.75 | $1,024.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $139.22 / $181.00 / $355.04
| Facility | | $139.22 | $181.00 | $355.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.94 / $341.38 / $708.94
| Professional | | $188.94 | $341.38 | $708.94 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $220.86 / $220.86 / $308.82
| Professional | 50 | $220.86 | $220.86 | $308.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $210.10 / $210.10 / $210.10
| Facility | | $210.10 | $210.10 | $210.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.77 / $366.92 / $777.03
| Professional | | $145.77 | $366.92 | $777.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $119.09 / $214.32 / $6,679.00
| Facility | | $119.09 | $214.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.52 / $392.17 / $547.76
| Professional | | $309.52 | $392.17 | $547.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.94 / $337.92 / $753.22
| Professional | | $142.94 | $337.92 | $753.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,863.50 / $3,863.50 / $3,863.50
| Facility | | $3,863.50 | $3,863.50 | $3,863.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.82 / $186.44 / $444.35
| Professional | | $140.82 | $186.44 | $444.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $966.90 / $3,445.00
| Facility | | $55.00 | $966.90 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.12 / $485.62 / $2,056.15
| Professional | | $300.12 | $485.62 | $2,056.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $1,790.00 / $2,733.00
| Facility | | $500.00 | $1,790.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.07 / $400.34 / $837.61
| Professional | | $282.07 | $400.34 | $837.61 |