- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $271.75 / $2,663.12 / $3,625.00
| Facility | | $271.75 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.38 / $210.71 / $348.39
| Professional | | $145.38 | $210.71 | $348.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $152.88 / $2,329.00 / $4,689.00
| Facility | | $152.88 | $2,329.00 | $4,689.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.28 / $349.63 / $1,949.92
| Professional | | $121.28 | $349.63 | $1,949.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.59 / $140.82 / $262.45
| Facility | | $109.59 | $140.82 | $262.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.36 / $243.45 / $422.50
| Professional | | $150.36 | $243.45 | $422.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.94 / $270.33 / $564.86
| Professional | | $138.94 | $270.33 | $564.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $96.51 / $199.82 / $6,679.00
| Facility | | $96.51 | $199.82 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.61 / $236.95 / $326.44
| Professional | | $195.61 | $236.95 | $326.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.86 / $260.43 / $489.74
| Professional | | $123.86 | $260.43 | $489.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.66 / $237.66 / $237.66
| Professional | | $237.66 | $237.66 | $237.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,338.00 / $8,498.00
| Facility | | $55.00 | $2,338.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.43 / $509.84 / $1,949.92
| Professional | | $270.43 | $509.84 | $1,949.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.85 / $406.42 / $715.68
| Professional | | $253.85 | $406.42 | $715.68 |