- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $887.45 / $2,083.00 / $3,685.00
| Facility | | $887.45 | $2,083.00 | $3,685.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.18 / $193.30 / $485.07
| Professional | | $159.18 | $193.30 | $485.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $395.54 / $947.00 / $4,289.00
| Facility | | $395.54 | $947.00 | $4,289.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.69 / $319.69 / $1,665.00
| Professional | | $177.69 | $319.69 | $1,665.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.10 / $344.67 / $448.61
| Professional | | $263.10 | $344.67 | $448.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.41 / $305.42 / $483.56
| Professional | | $201.41 | $305.42 | $483.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $179.55 / $375.98 / $6,679.00
| Facility | | $179.55 | $375.98 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.99 / $244.39 / $330.86
| Professional | | $201.99 | $244.39 | $330.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.32 / $414.15 / $554.10
| Professional | | $218.32 | $414.15 | $554.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $844.15 / $912.18 / $913.04
| Facility | | $844.15 | $912.18 | $913.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.02 / $273.02 / $285.83
| Professional | | $273.02 | $273.02 | $285.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $460.87 / $1,856.00 / $12,000.00
| Facility | | $460.87 | $1,856.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.18 / $335.60 / $1,665.00
| Professional | | $199.18 | $335.60 | $1,665.00 |
- 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
- $193.03 / $283.14 / $525.88
| Professional | | $193.03 | $283.14 | $525.88 |