- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.55 / $1,473.20 / $3,625.00
| Facility | | $308.55 | $1,473.20 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.14 / $263.50 / $633.75
| Professional | | $180.14 | $263.50 | $633.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $189.62 / $818.35 / $2,796.00
| Facility | | $189.62 | $818.35 | $2,796.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.26 / $341.07 / $1,242.24
| Professional | | $183.26 | $341.07 | $1,242.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.75 / $322.75 / $322.75
| Professional | | $322.75 | $322.75 | $322.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.33 / $357.06 / $634.58
| Professional | | $241.33 | $357.06 | $634.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $168.71 / $269.14 / $6,679.00
| Facility | | $168.71 | $269.14 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.59 / $242.23 / $437.38
| Professional | | $193.59 | $242.23 | $437.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.76 / $419.79 / $533.00
| Professional | | $211.76 | $419.79 | $533.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $527.26 / $619.42 / $2,745.25
| Facility | | $527.26 | $619.42 | $2,745.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.87 / $485.65 / $528.29
| Professional | | $375.87 | $485.65 | $528.29 |
- 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
- $226.81 / $367.47 / $1,242.24
| Professional | | $226.81 | $367.47 | $1,242.24 |
- 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
- $211.76 / $339.44 / $673.74
| Professional | | $211.76 | $339.44 | $673.74 |