- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $438.57 / $2,083.00 / $3,625.00
| Facility | | $438.57 | $2,083.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.08 / $438.36 / $736.43
| Professional | | $256.08 | $438.36 | $736.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.00 / $810.69 / $2,713.00
| Facility | | $308.00 | $810.69 | $2,713.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.92 / $606.46 / $2,648.00
| Professional | | $277.92 | $606.46 | $2,648.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $297.18 / $386.33 / $681.73
| Facility | | $297.18 | $386.33 | $681.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $403.27 / $646.57 / $1,033.10
| Professional | | $403.27 | $646.57 | $1,033.10 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $308.82 / $308.82 / $672.53
| Professional | 50 | $308.82 | $308.82 | $672.53 |
- 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
- $335.47 / $626.10 / $1,156.55
| Professional | | $335.47 | $626.10 | $1,156.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $256.39 / $541.86 / $6,679.00
| Facility | | $256.39 | $541.86 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.58 / $601.27 / $830.51
| Professional | | $474.58 | $601.27 | $830.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.25 / $648.90 / $1,155.84
| Professional | | $309.25 | $648.90 | $1,155.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,863.50 / $3,863.50 / $3,863.69
| Facility | | $3,863.50 | $3,863.50 | $3,863.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,730.22 / $3,445.00
| Facility | | $55.00 | $1,730.22 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $465.34 / $779.02 / $4,283.00
| Professional | | $465.34 | $779.02 | $4,283.00 |
- 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
- $429.57 / $629.16 / $1,309.83
| Professional | | $429.57 | $629.16 | $1,309.83 |