- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $152.05 / $2,079.00 / $3,625.00
| Facility | | $152.05 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.07 / $219.78 / $560.20
| Professional | | $111.07 | $219.78 | $560.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $195.48 / $941.10 / $4,050.00
| Facility | | $195.48 | $941.10 | $4,050.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.35 / $422.82 / $1,852.56
| Professional | | $185.35 | $422.82 | $1,852.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $200.68 / $260.88 / $460.36
| Facility | | $200.68 | $260.88 | $460.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.01 / $400.56 / $640.77
| Professional | | $239.01 | $400.56 | $640.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.01 / $377.35 / $683.54
| Professional | | $215.01 | $377.35 | $683.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $172.00 / $300.00 / $8,090.00
| Facility | | $172.00 | $300.00 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.41 / $297.39 / $440.59
| Professional | | $161.41 | $297.39 | $440.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.04 / $482.53 / $716.73
| Professional | | $225.04 | $482.53 | $716.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.00 / $408.00 / $541.83
| Professional | | $338.00 | $408.00 | $541.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,078.00 / $5,876.00
| Facility | | $55.00 | $2,078.00 | $5,876.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.37 / $562.62 / $1,852.56
| Professional | | $178.37 | $562.62 | $1,852.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,372.00 / $5,876.00
| Facility | | $953.00 | $3,372.00 | $5,876.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.55 / $348.42 / $719.29
| Professional | | $173.55 | $348.42 | $719.29 |