- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $236.14 / $1,886.00 / $3,625.00
| Facility | | $236.14 | $1,886.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.52 / $197.53 / $345.22
| Professional | | $74.52 | $197.53 | $345.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $252.61 / $2,410.09 / $12,000.00
| Facility | | $252.61 | $2,410.09 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.99 / $402.24 / $1,920.48
| Professional | | $118.99 | $402.24 | $1,920.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.26 / $119.84 / $237.81
| Facility | | $93.26 | $119.84 | $237.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.81 / $289.11 / $663.39
| Professional | | $118.81 | $289.11 | $663.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.00 / $500.00 / $3,111.82
| Facility | | $443.00 | $500.00 | $3,111.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.45 / $280.72 / $741.53
| Professional | | $103.45 | $280.72 | $741.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $377.00 / $6,679.00
| Facility | | $83.43 | $377.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.67 / $409.06 / $580.38
| Professional | | $312.67 | $409.06 | $580.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.44 / $329.73 / $732.03
| Professional | | $119.44 | $329.73 | $732.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.76 / $125.76 / $125.76
| Professional | | $125.76 | $125.76 | $125.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $498.99 / $2,854.00 / $12,000.00
| Facility | | $498.99 | $2,854.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.95 / $649.74 / $1,920.48
| Professional | | $260.95 | $649.74 | $1,920.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $2,854.00 / $5,714.00
| Facility | | $1,061.00 | $2,854.00 | $5,714.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.30 / $383.47 / $914.07
| Professional | | $219.30 | $383.47 | $914.07 |