- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $205.83 / $1,886.00 / $3,625.00
| Facility | | $205.83 | $1,886.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.68 / $205.83 / $374.07
| Professional | | $147.68 | $205.83 | $374.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.00 / $716.81 / $2,713.00
| Facility | | $308.00 | $716.81 | $2,713.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.96 / $300.18 / $1,061.59
| Professional | | $156.96 | $300.18 | $1,061.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $174.19 / $226.45 / $399.59
| Facility | | $174.19 | $226.45 | $399.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.97 / $347.68 / $545.17
| Professional | | $226.97 | $347.68 | $545.17 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $303.23 / $303.23 / $308.82
| Professional | 50 | $303.23 | $303.23 | $308.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $50.00 / $191.86
| Facility | | $50.00 | $50.00 | $191.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.44 / $338.61 / $589.52
| Professional | | $157.44 | $338.61 | $589.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $149.08 / $238.22 / $6,679.00
| Facility | | $149.08 | $238.22 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.38 / $304.56 / $421.24
| Professional | | $240.38 | $304.56 | $421.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.00 / $390.22 / $657.99
| Professional | | $179.00 | $390.22 | $657.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,014.24 / $1,014.24 / $1,014.24
| Facility | | $1,014.24 | $1,014.24 | $1,014.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $487.39 / $487.39 / $487.39
| Professional | | $487.39 | $487.39 | $487.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,000.92 / $3,445.00
| Facility | | $55.00 | $1,000.92 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.08 / $381.87 / $1,917.67
| Professional | | $228.08 | $381.87 | $1,917.67 |
- 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
- $204.48 / $300.18 / $641.42
| Professional | | $204.48 | $300.18 | $641.42 |