- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $212.16 / $1,886.00 / $3,625.00
| Facility | | $212.16 | $1,886.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.13 / $212.16 / $549.98
| Professional | | $135.13 | $212.16 | $549.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.00 / $736.00 / $7,231.00
| Facility | | $308.00 | $736.00 | $7,231.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.88 / $352.16 / $1,600.88
| Professional | | $150.88 | $352.16 | $1,600.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.65 / $199.75 / $352.47
| Facility | | $153.65 | $199.75 | $352.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.19 / $364.74 / $713.21
| Professional | | $210.19 | $364.74 | $713.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.87 / $360.58 / $691.84
| Professional | | $188.87 | $360.58 | $691.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.15 / $300.00 / $6,679.00
| Facility | | $134.15 | $300.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.47 / $268.58 / $412.20
| Professional | | $139.47 | $268.58 | $412.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.20 / $364.44 / $606.95
| Professional | | $169.20 | $364.44 | $606.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $571.54 / $571.54 / $586.98
| Facility | | $571.54 | $571.54 | $586.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.65 / $210.65 / $215.99
| Professional | | $210.65 | $210.65 | $215.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $2,028.00 / $12,000.00
| Facility | | $627.00 | $2,028.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.65 / $643.99 / $1,600.88
| Professional | | $247.65 | $643.99 | $1,600.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $2,733.00
| Facility | | $627.00 | $1,818.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.82 / $416.65 / $780.01
| Professional | | $241.82 | $416.65 | $780.01 |