- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $252.59 / $2,515.57 / $3,625.00
| Facility | | $252.59 | $2,515.57 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.63 / $225.71 / $410.19
| Professional | | $125.63 | $225.71 | $410.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $220.48 / $1,251.81 / $3,472.00
| Facility | | $220.48 | $1,251.81 | $3,472.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.99 / $378.25 / $1,942.33
| Professional | | $172.99 | $378.25 | $1,942.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.52 / $202.41 / $372.49
| Facility | | $157.52 | $202.41 | $372.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.13 / $319.36 / $518.25
| Professional | | $167.13 | $319.36 | $518.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.16 / $325.75 / $639.30
| Professional | | $176.16 | $325.75 | $639.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $136.06 / $215.42 / $6,679.00
| Facility | | $136.06 | $215.42 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.76 / $335.22 / $463.32
| Professional | | $274.76 | $335.22 | $463.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.89 / $363.69 / $689.29
| Professional | | $172.89 | $363.69 | $689.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.10 / $586.98 / $4,572.24
| Facility | | $158.10 | $586.98 | $4,572.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.00 / $373.64 / $510.00
| Professional | | $250.00 | $373.64 | $510.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,600.00 / $7,161.00
| Facility | | $55.00 | $1,600.00 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.49 / $526.66 / $1,942.33
| Professional | | $275.49 | $526.66 | $1,942.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $950.00 / $2,408.00 / $7,161.00
| Facility | | $950.00 | $2,408.00 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.58 / $399.24 / $729.52
| Professional | | $259.58 | $399.24 | $729.52 |