- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $224.07 / $2,067.00 / $3,685.00
| Facility | | $224.07 | $2,067.00 | $3,685.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.74 / $249.70 / $440.08
| Professional | | $170.74 | $249.70 | $440.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $408.96 / $2,871.43 / $10,821.00
| Facility | | $408.96 | $2,871.43 | $10,821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.53 / $441.82 / $2,757.97
| Professional | | $176.53 | $441.82 | $2,757.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.67 / $259.57 / $458.04
| Facility | | $199.67 | $259.57 | $458.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.14 / $434.42 / $712.03
| Professional | | $273.14 | $434.42 | $712.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.22 / $425.01 / $872.87
| Professional | | $241.22 | $425.01 | $872.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $172.18 / $364.08 / $6,679.00
| Facility | | $172.18 | $364.08 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.78 / $277.56 / $430.38
| Professional | | $145.78 | $277.56 | $430.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.54 / $460.02 / $635.91
| Professional | | $214.54 | $460.02 | $635.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.01 / $316.01 / $316.01
| Professional | | $316.01 | $316.01 | $316.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $852.34 / $3,649.00 / $12,000.00
| Facility | | $852.34 | $3,649.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.44 / $684.27 / $2,757.97
| Professional | | $284.44 | $684.27 | $2,757.97 |
- 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
- $260.10 / $431.57 / $802.29
| Professional | | $260.10 | $431.57 | $802.29 |