- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $183.15 / $2,581.76 / $3,625.00
| Facility | | $183.15 | $2,581.76 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.95 / $198.57 / $404.46
| Professional | | $117.95 | $198.57 | $404.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $381.39 / $1,251.81 / $7,161.00
| Facility | | $381.39 | $1,251.81 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.76 / $351.74 / $1,133.52
| Professional | | $171.76 | $351.74 | $1,133.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $184.66 / $240.06 / $423.61
| Facility | | $184.66 | $240.06 | $423.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.58 / $383.48 / $624.45
| Professional | | $250.58 | $383.48 | $624.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.30 / $318.95 / $646.25
| Professional | | $179.30 | $318.95 | $646.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.93 / $252.53 / $6,679.00
| Facility | | $158.93 | $252.53 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.56 / $333.63 / $460.54
| Professional | | $263.56 | $333.63 | $460.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.51 / $407.54 / $699.83
| Professional | | $192.51 | $407.54 | $699.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $187.82 / $393.46 / $1,494.48
| Facility | | $187.82 | $393.46 | $1,494.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.65 / $374.65 / $374.65
| Professional | | $374.65 | $374.65 | $374.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.30 / $2,078.00 / $11,500.00
| Facility | | $1,071.30 | $2,078.00 | $11,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.05 / $449.21 / $1,708.48
| Professional | | $256.05 | $449.21 | $1,708.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.00 / $2,408.00 / $5,683.00
| Facility | | $1,106.00 | $2,408.00 | $5,683.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.20 / $332.82 / $687.97
| Professional | | $203.20 | $332.82 | $687.97 |