- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $195.21 / $2,116.27 / $6,432.00
| Facility | | $195.21 | $2,116.27 | $6,432.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.55 / $175.71 / $310.11
| Professional | | $146.55 | $175.71 | $310.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.31 / $268.31 / $268.31
| Professional | | $268.31 | $268.31 | $268.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,083.51 / $1,395.00 / $12,759.45
| Facility | | $1,083.51 | $1,395.00 | $12,759.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.85 / $289.72 / $388.17
| Professional | | $179.85 | $289.72 | $388.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.25 / $230.22 / $367.72
| Professional | | $173.25 | $230.22 | $367.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.54 / $283.22 / $284.95
| Professional | | $213.54 | $283.22 | $284.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $923.63 / $1,148.40 / $8,875.18
| Facility | | $923.63 | $1,148.40 | $8,875.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.00 / $2,070.00 / $7,197.00
| Facility | | $490.00 | $2,070.00 | $7,197.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.21 / $204.84 / $484.45
| Professional | | $150.21 | $204.84 | $484.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $209.50 / $469.90
| Professional | | $6.00 | $209.50 | $469.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.43 / $230.22 / $367.72
| Professional | | $173.43 | $230.22 | $367.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $152.12 / $162.77 / $183.23
| Facility | | $152.12 | $162.77 | $183.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.12 / $172.73 / $187.89
| Professional | | $152.12 | $172.73 | $187.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $471.00 / $1,305.00 / $3,742.00
| Facility | | $471.00 | $1,305.00 | $3,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.81 / $220.57 / $365.33
| Professional | | $162.81 | $220.57 | $365.33 |