- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.92 / $2,067.00 / $3,625.00
| Facility | | $226.92 | $2,067.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.54 / $258.60 / $600.00
| Professional | | $177.54 | $258.60 | $600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $421.29 / $3,315.28 / $10,821.00
| Facility | | $421.29 | $3,315.28 | $10,821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.17 / $416.57 / $2,321.00
| Professional | | $175.17 | $416.57 | $2,321.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.33 / $269.52 / $475.62
| Facility | | $207.33 | $269.52 | $475.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.14 / $426.20 / $861.70
| Professional | | $250.14 | $426.20 | $861.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.03 / $283.52 / $6,679.00
| Facility | | $175.03 | $283.52 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.00 / $260.32 / $419.69
| Professional | | $142.00 | $260.32 | $419.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.26 / $469.88 / $648.42
| Professional | | $221.26 | $469.88 | $648.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,311.60 / $4,311.60 / $4,311.60
| Facility | | $4,311.60 | $4,311.60 | $4,311.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $888.20 / $3,649.00 / $12,000.00
| Facility | | $888.20 | $3,649.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.89 / $484.32 / $2,321.00
| Professional | | $253.89 | $484.32 | $2,321.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.78 / $354.09 / $784.83
| Professional | | $253.78 | $354.09 | $784.83 |