- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $202.57 / $937.76 / $1,771.31
| Facility | | $202.57 | $937.76 | $1,771.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.57 / $375.91 / $572.36
| Professional | | $202.57 | $375.91 | $572.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.18 / $587.19 / $1,296.41
| Facility | | $380.18 | $587.19 | $1,296.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.05 / $416.78 / $1,652.80
| Professional | | $175.05 | $416.78 | $1,652.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.00 / $1,169.74 / $2,045.00
| Facility | | $818.00 | $1,169.74 | $2,045.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $325.08 / $568.91 / $948.19
| Facility | | $325.08 | $568.91 | $948.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.62 / $439.59 / $1,086.19
| Professional | | $250.62 | $439.59 | $1,086.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $3,472.00 / $9,239.00
| Facility | | $83.43 | $3,472.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $601.16 / $601.16 / $707.26
| Professional | | $601.16 | $601.16 | $707.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.78 / $416.78 / $1,290.73
| Professional | | $416.78 | $416.78 | $1,290.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $453.34 / $478.75 / $537.00
| Facility | | $453.34 | $478.75 | $537.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.20 / $1,979.71 / $1,979.71
| Facility | | $725.20 | $1,979.71 | $1,979.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.63 / $250.07 / $2,083.90
| Professional | | $173.63 | $250.07 | $2,083.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $237.69 / $417.68 / $583.49
| Facility | | $237.69 | $417.68 | $583.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.63 / $250.07 / $708.98
| Professional | | $173.63 | $250.07 | $708.98 |