- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $243.12 / $1,886.00 / $3,625.00
| Facility | | $243.12 | $1,886.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $246.22 / $416.63
| Professional | | $213.80 | $246.22 | $416.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.00 / $766.70 / $2,713.00
| Facility | | $308.00 | $766.70 | $2,713.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.53 / $500.70 / $1,952.72
| Professional | | $253.53 | $500.70 | $1,952.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $282.58 / $363.13 / $648.26
| Facility | | $282.58 | $363.13 | $648.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.28 / $488.91 / $704.45
| Professional | | $336.28 | $488.91 | $704.45 |
- 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
- $263.50 / $433.90 / $739.34
| Professional | | $263.50 | $433.90 | $739.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.32 / $360.70 / $6,679.00
| Facility | | $214.32 | $360.70 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.73 / $376.40 / $519.53
| Professional | | $310.73 | $376.40 | $519.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.45 / $591.98 / $764.79
| Professional | | $292.45 | $591.98 | $764.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $827.28 / $827.28 / $827.28
| Facility | | $827.28 | $827.28 | $827.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,210.10 / $3,445.00
| Facility | | $55.00 | $1,210.10 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.20 / $558.38 / $1,952.72
| Professional | | $295.20 | $558.38 | $1,952.72 |
- 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
- $283.68 / $416.22 / $797.89
| Professional | | $283.68 | $416.22 | $797.89 |