- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $274.82 / $2,079.00 / $3,625.00
| Facility | | $274.82 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.78 / $284.70 / $439.47
| Professional | | $244.78 | $284.70 | $439.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.00 / $1,078.00 / $5,661.83
| Facility | | $308.00 | $1,078.00 | $5,661.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.47 / $518.99 / $2,035.29
| Professional | | $260.47 | $518.99 | $2,035.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $280.60 / $360.57 / $643.70
| Facility | | $280.60 | $360.57 | $643.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.91 / $480.98 / $696.45
| Professional | | $333.91 | $480.98 | $696.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $50.00 / $50.00
| Facility | | $50.00 | $50.00 | $50.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.20 / $464.81 / $813.35
| Professional | | $281.20 | $464.81 | $813.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $241.30 / $511.64 / $6,679.00
| Facility | | $241.30 | $511.64 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.36 / $367.47 / $505.44
| Professional | | $303.36 | $367.47 | $505.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.41 / $594.29 / $788.47
| Professional | | $290.41 | $594.29 | $788.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,205.65 / $3,445.00
| Facility | | $55.00 | $1,205.65 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.02 / $587.91 / $2,035.29
| Professional | | $319.02 | $587.91 | $2,035.29 |
- 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
- $300.02 / $459.45 / $827.32
| Professional | | $300.02 | $459.45 | $827.32 |