- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $179.97 / $2,618.00 / $3,625.00
| Facility | | $179.97 | $2,618.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.84 / $179.97 / $482.68
| Professional | | $95.84 | $179.97 | $482.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $289.33 / $2,948.45 / $10,821.00
| Facility | | $289.33 | $2,948.45 | $10,821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.94 / $378.58 / $1,917.60
| Professional | | $148.94 | $378.58 | $1,917.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $139.91 / $181.88 / $356.77
| Facility | | $139.91 | $181.88 | $356.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.44 / $229.44 / $535.87
| Professional | | $229.44 | $229.44 | $535.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.82 / $410.26 / $854.94
| Professional | | $190.82 | $410.26 | $854.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $121.18 / $300.00 / $6,679.00
| Facility | | $121.18 | $300.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.61 / $391.22 / $615.55
| Professional | | $309.61 | $391.22 | $615.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.57 / $328.09 / $728.39
| Professional | | $151.57 | $328.09 | $728.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.84 / $461.84 / $461.84
| Professional | | $461.84 | $461.84 | $461.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $957.04 / $3,649.00 / $16,394.00
| Facility | | $957.04 | $3,649.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.08 / $680.93 / $1,917.60
| Professional | | $282.08 | $680.93 | $1,917.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,592.00 / $8,425.00
| Facility | | $1,640.00 | $3,592.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.19 / $378.58 / $826.43
| Professional | | $267.19 | $378.58 | $826.43 |