- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $265.74 / $2,067.00 / $3,625.00
| Facility | | $265.74 | $2,067.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.32 / $235.24 / $435.18
| Professional | | $134.32 | $235.24 | $435.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.36 / $4,287.00 / $9,830.12
| Facility | | $338.36 | $4,287.00 | $9,830.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.47 / $413.66 / $2,859.26
| Professional | | $177.47 | $413.66 | $2,859.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $170.02 / $218.48 / $390.03
| Facility | | $170.02 | $218.48 | $390.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.34 / $347.39 / $644.25
| Professional | | $199.34 | $347.39 | $644.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $146.68 / $310.02 / $6,679.00
| Facility | | $146.68 | $310.02 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.47 / $337.30 / $465.66
| Professional | | $276.47 | $337.30 | $465.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.09 / $394.67 / $706.70
| Professional | | $187.09 | $394.67 | $706.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,928.58 / $1,928.58 / $1,928.58
| Facility | | $1,928.58 | $1,928.58 | $1,928.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $990.30 / $4,983.00 / $12,000.00
| Facility | | $990.30 | $4,983.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.58 / $665.45 / $2,859.26
| Professional | | $292.58 | $665.45 | $2,859.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $4,983.00 / $8,810.00
| Facility | | $2,155.00 | $4,983.00 | $8,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.14 / $452.48 / $857.07
| Professional | | $287.14 | $452.48 | $857.07 |