- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $187.11 / $2,410.00 / $3,469.00
| Facility | | $187.11 | $2,410.00 | $3,469.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.95 / $257.07 / $432.61
| Professional | | $170.95 | $257.07 | $432.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $198.42 / $941.10 / $16,394.00
| Facility | | $198.42 | $941.10 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.04 / $496.49 / $2,209.12
| Professional | | $233.04 | $496.49 | $2,209.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.42 / $280.67 / $500.62
| Facility | | $218.42 | $280.67 | $500.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.69 / $149.69 / $204.74
| Professional | | $149.69 | $149.69 | $204.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $219.46 / $276.31 / $652.29
| Facility | | $219.46 | $276.31 | $652.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.58 / $422.75 / $850.53
| Professional | | $218.58 | $422.75 | $850.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $187.24 / $506.00 / $6,679.00
| Facility | | $187.24 | $506.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $357.54 / $463.79 / $663.67
| Professional | | $357.54 | $463.79 | $663.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.22 / $503.71 / $843.76
| Professional | | $269.22 | $503.71 | $843.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.00 / $1,259.52 / $16,394.00
| Facility | | $308.00 | $1,259.52 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.47 / $752.28 / $2,209.12
| Professional | | $308.47 | $752.28 | $2,209.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.00 / $1,078.00 / $2,733.00
| Facility | | $308.00 | $1,078.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.64 / $429.51 / $990.31
| Professional | | $267.64 | $429.51 | $990.31 |