- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.97 / $1,886.00 / $3,363.00
| Facility | | $150.97 | $1,886.00 | $3,363.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.35 / $219.86 / $373.53
| Professional | | $140.35 | $219.86 | $373.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.72 / $1,089.00 / $5,047.31
| Facility | | $141.72 | $1,089.00 | $5,047.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.28 / $386.47 / $1,613.36
| Professional | | $187.28 | $386.47 | $1,613.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $167.53 / $215.28 / $383.98
| Facility | | $167.53 | $215.28 | $383.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,620.25 / $1,620.25 / $1,620.25
| Professional | | $1,620.25 | $1,620.25 | $1,620.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $265.36 / $334.09 / $500.00
| Facility | | $265.36 | $334.09 | $500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.60 / $338.67 / $668.92
| Professional | | $181.60 | $338.67 | $668.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.82 / $377.00 / $6,679.00
| Facility | | $143.82 | $377.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.07 / $335.30 / $536.23
| Professional | | $259.07 | $335.30 | $536.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.93 / $384.68 / $608.77
| Professional | | $204.93 | $384.68 | $608.77 |
- 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
- $276.33 / $571.12 / $1,613.36
| Professional | | $276.33 | $571.12 | $1,613.36 |
- 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
- $244.51 / $376.62 / $902.52
| Professional | | $244.51 | $376.62 | $902.52 |