- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $247.29 / $2,083.00 / $3,625.00
| Facility | | $247.29 | $2,083.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.19 / $247.29 / $316.14
| Professional | | $219.19 | $247.29 | $316.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $289.72 / $1,981.00 / $7,909.30
| Facility | | $289.72 | $1,981.00 | $7,909.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.03 / $449.57 / $1,746.48
| Professional | | $243.03 | $449.57 | $1,746.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.99 / $286.99 / $286.99
| Professional | | $286.99 | $286.99 | $286.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.00 / $500.00 / $3,103.98
| Facility | | $443.00 | $500.00 | $3,103.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.41 / $422.75 / $770.01
| Professional | | $245.41 | $422.75 | $770.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $3,343.00 / $8,090.00
| Facility | | $83.43 | $3,343.00 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.41 / $329.41 / $387.54
| Professional | | $329.41 | $329.41 | $387.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.10 / $598.32 / $772.60
| Professional | | $303.10 | $598.32 | $772.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,575.00 / $7,909.30
| Facility | | $55.00 | $2,575.00 | $7,909.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.42 / $457.33 / $1,746.48
| Professional | | $261.42 | $457.33 | $1,746.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $3,715.00 / $8,766.00
| Facility | | $1,061.00 | $3,715.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.99 / $366.30 / $831.51
| Professional | | $252.99 | $366.30 | $831.51 |