- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.94 / $2,581.76 / $3,625.00
| Facility | | $257.94 | $2,581.76 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.41 / $274.11 / $582.29
| Professional | | $162.41 | $274.11 | $582.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $472.94 / $1,052.09 / $3,445.00
| Facility | | $472.94 | $1,052.09 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.96 / $487.92 / $1,457.52
| Professional | | $218.96 | $487.92 | $1,457.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $235.82 / $306.57 / $540.97
| Facility | | $235.82 | $306.57 | $540.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.83 / $513.07 / $852.22
| Professional | | $297.83 | $513.07 | $852.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.19 / $497.73 / $1,049.83
| Professional | | $252.19 | $497.73 | $1,049.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $203.67 / $430.00 / $6,679.00
| Facility | | $203.67 | $430.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.51 / $477.02 / $658.47
| Professional | | $376.51 | $477.02 | $658.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.40 / $524.49 / $955.37
| Professional | | $247.40 | $524.49 | $955.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.00 / $510.00 / $510.00
| Professional | | $510.00 | $510.00 | $510.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $16,394.00
| Facility | | $627.00 | $1,818.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.99 / $632.22 / $2,438.08
| Professional | | $328.99 | $632.22 | $2,438.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $2,733.00
| Facility | | $627.00 | $1,818.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.88 / $478.24 / $988.55
| Professional | | $280.88 | $478.24 | $988.55 |