- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.68 / $1,823.00 / $3,363.00
| Facility | | $177.68 | $1,823.00 | $3,363.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.34 / $228.16 / $367.57
| Professional | | $163.34 | $228.16 | $367.57 |
- 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
- $212.34 / $455.15 / $2,401.00
| Professional | | $212.34 | $455.15 | $2,401.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.49 / $275.62 / $491.61
| Facility | | $214.49 | $275.62 | $491.61 |
- 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
- $209.67 / $387.41 / $749.15
| Professional | | $209.67 | $387.41 | $749.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $184.24 / $391.10 / $6,679.00
| Facility | | $184.24 | $391.10 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.42 / $386.32 / $558.01
| Professional | | $299.42 | $386.32 | $558.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.41 / $492.67 / $706.76
| Professional | | $263.41 | $492.67 | $706.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.00 / $1,240.32 / $12,000.00
| Facility | | $308.00 | $1,240.32 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.83 / $624.05 / $2,401.00
| Professional | | $289.83 | $624.05 | $2,401.00 |
- 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
- $258.06 / $408.95 / $1,137.39
| Professional | | $258.06 | $408.95 | $1,137.39 |