- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $113.15 / $1,845.24 / $3,469.00
| Facility | | $113.15 | $1,845.24 | $3,469.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.29 / $153.25 / $556.75
| Professional | | $112.29 | $153.25 | $556.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $290.92 / $650.61 / $2,733.00
| Facility | | $290.92 | $650.61 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.73 / $274.36 / $1,044.56
| Professional | | $119.73 | $274.36 | $1,044.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $152.41 / $197.83 / $349.63
| Facility | | $152.41 | $197.83 | $349.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.33 / $269.92 / $380.57
| Professional | | $208.33 | $269.92 | $380.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.65 / $276.86 / $523.51
| Professional | | $159.65 | $276.86 | $523.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.25 / $300.00 / $6,679.00
| Facility | | $130.25 | $300.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.50 / $167.40 / $264.12
| Professional | | $91.50 | $167.40 | $264.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.69 / $324.97 / $446.81
| Professional | | $157.69 | $324.97 | $446.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.32 / $611.28 / $1,718.81
| Facility | | $175.32 | $611.28 | $1,718.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.00 / $206.86 / $309.51
| Professional | | $172.00 | $206.86 | $309.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,078.00 / $3,445.00
| Facility | | $55.00 | $1,078.00 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.85 / $337.48 / $1,044.56
| Professional | | $157.85 | $337.48 | $1,044.56 |
- 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
- $143.91 / $216.71 / $441.76
| Professional | | $143.91 | $216.71 | $441.76 |