- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $185.78 / $1,823.00 / $3,363.00
| Facility | | $185.78 | $1,823.00 | $3,363.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.79 / $226.41 / $363.91
| Professional | | $172.79 | $226.41 | $363.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.00 / $1,027.76 / $12,000.00
| Facility | | $308.00 | $1,027.76 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.74 / $457.21 / $1,826.56
| Professional | | $213.74 | $457.21 | $1,826.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.96 / $287.79 / $513.32
| Facility | | $223.96 | $287.79 | $513.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.74 / $353.73 / $353.73
| Professional | | $204.74 | $353.73 | $353.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.00 / $482.73 / $607.77
| Facility | | $443.00 | $482.73 | $607.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.36 / $388.94 / $727.70
| Professional | | $216.36 | $388.94 | $727.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $192.51 / $408.38 / $6,679.00
| Facility | | $192.51 | $408.38 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.19 / $376.02 / $543.13
| Professional | | $292.19 | $376.02 | $543.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.30 / $508.66 / $691.35
| Professional | | $265.30 | $508.66 | $691.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.00 / $1,296.66 / $12,000.00
| Facility | | $308.00 | $1,296.66 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.99 / $604.35 / $1,826.56
| Professional | | $284.99 | $604.35 | $1,826.56 |
- 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
- $261.24 / $387.25 / $795.22
| Professional | | $261.24 | $387.25 | $795.22 |