- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.49 / $1,823.00 / $3,363.00
| Facility | | $151.49 | $1,823.00 | $3,363.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.77 / $195.97 / $306.58
| Professional | | $142.77 | $195.97 | $306.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.60 / $1,064.64 / $3,472.00
| Facility | | $131.60 | $1,064.64 | $3,472.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.84 / $375.91 / $1,593.12
| Professional | | $173.84 | $375.91 | $1,593.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $187.00 / $240.30 / $428.60
| Facility | | $187.00 | $240.30 | $428.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.82 / $370.85 / $579.70
| Professional | | $255.82 | $370.85 | $579.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.08 / $346.34 / $1,034.00
| Facility | | $275.08 | $346.34 | $1,034.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.65 / $340.63 / $657.10
| Professional | | $188.65 | $340.63 | $657.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $156.01 / $255.74 / $6,679.00
| Facility | | $156.01 | $255.74 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.99 / $333.65 / $477.03
| Professional | | $256.99 | $333.65 | $477.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.71 / $422.16 / $678.39
| Professional | | $225.71 | $422.16 | $678.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,064.64 / $3,804.00
| Facility | | $55.00 | $1,064.64 | $3,804.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.66 / $494.30 / $1,593.12
| Professional | | $250.66 | $494.30 | $1,593.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $473.00 / $1,878.00 / $4,142.00
| Facility | | $473.00 | $1,878.00 | $4,142.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.19 / $341.85 / $701.67
| Professional | | $225.19 | $341.85 | $701.67 |