- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.47 / $2,083.00 / $3,625.00
| Facility | | $143.47 | $2,083.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.51 / $154.02 / $285.45
| Professional | | $129.51 | $154.02 | $285.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $396.00 / $2,338.00 / $12,000.00
| Facility | | $396.00 | $2,338.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.24 / $300.47 / $1,865.75
| Professional | | $144.24 | $300.47 | $1,865.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $452.37 / $1,263.74 / $1,263.74
| Professional | | $452.37 | $1,263.74 | $1,263.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.00 / $1,527.80 / $2,000.00
| Facility | | $443.00 | $1,527.80 | $2,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.52 / $278.79 / $495.64
| Professional | | $167.52 | $278.79 | $495.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $377.00 / $6,679.00
| Facility | | $134.90 | $377.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.76 / $191.76 / $342.86
| Professional | | $151.76 | $191.76 | $342.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.66 / $325.04 / $430.60
| Professional | | $164.66 | $325.04 | $430.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $739.20 / $3,649.00 / $12,000.00
| Facility | | $739.20 | $3,649.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.91 / $320.74 / $1,865.75
| Professional | | $157.91 | $320.74 | $1,865.75 |
- 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
- $152.80 / $265.35 / $495.45
| Professional | | $152.80 | $265.35 | $495.45 |