- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.86 / $1,823.00 / $3,363.00
| Facility | | $181.86 | $1,823.00 | $3,363.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.40 / $240.79 / $386.37
| Professional | | $166.40 | $240.79 | $386.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.43 / $1,333.68 / $4,569.00
| Facility | | $214.43 | $1,333.68 | $4,569.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.30 / $517.15 / $2,174.08
| Professional | | $209.30 | $517.15 | $2,174.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $238.61 / $306.61 / $546.89
| Facility | | $238.61 | $306.61 | $546.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $928.83 / $928.83 / $928.83
| Professional | | $928.83 | $928.83 | $928.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $433.49 / $455.01 / $545.78
| Facility | | $433.49 | $455.01 | $545.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.72 / $434.30 / $874.48
| Professional | | $204.72 | $434.30 | $874.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $200.83 / $435.08 / $6,679.00
| Facility | | $200.83 | $435.08 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.53 / $462.91 / $656.23
| Professional | | $353.53 | $462.91 | $656.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.77 / $528.94 / $822.89
| Professional | | $281.77 | $528.94 | $822.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,640.00 / $4,755.00
| Facility | | $55.00 | $1,640.00 | $4,755.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.24 / $735.57 / $2,174.08
| Professional | | $241.24 | $735.57 | $2,174.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $669.00 / $2,338.00 / $4,952.00
| Facility | | $669.00 | $2,338.00 | $4,952.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.06 / $449.95 / $1,150.94
| Professional | | $210.06 | $449.95 | $1,150.94 |