- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.99 / $2,079.00 / $3,685.00
| Facility | | $186.99 | $2,079.00 | $3,685.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.26 / $197.87 / $477.29
| Professional | | $133.26 | $197.87 | $477.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.94 / $3,315.28 / $10,821.00
| Facility | | $319.94 | $3,315.28 | $10,821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.77 / $354.05 / $1,728.01
| Professional | | $149.77 | $354.05 | $1,728.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $156.83 / $203.88 / $359.77
| Facility | | $156.83 | $203.88 | $359.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.86 / $346.12 / $682.56
| Professional | | $199.86 | $346.12 | $682.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $135.41 / $300.00 / $6,679.00
| Facility | | $135.41 | $300.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.26 / $235.44 / $366.21
| Professional | | $124.26 | $235.44 | $366.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.36 / $362.50 / $537.41
| Professional | | $168.36 | $362.50 | $537.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,577.42 / $3,577.42 / $3,577.42
| Facility | | $3,577.42 | $3,577.42 | $3,577.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.69 / $247.67 / $354.00
| Professional | | $204.69 | $247.67 | $354.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $670.84 / $3,649.00 / $12,000.00
| Facility | | $670.84 | $3,649.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.21 / $573.59 / $1,728.01
| Professional | | $239.21 | $573.59 | $1,728.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,450.00 / $3,592.00 / $8,498.00
| Facility | | $1,450.00 | $3,592.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.03 / $323.39 / $681.50
| Professional | | $218.03 | $323.39 | $681.50 |