- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.89 / $2,747.00 / $5,039.00
| Facility | | $311.89 | $2,747.00 | $5,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.21 / $330.52 / $493.91
| Professional | | $252.21 | $330.52 | $493.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,106.00 / $3,472.00
| Facility | | $540.00 | $1,106.00 | $3,472.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.38 / $431.25 / $2,726.00
| Professional | | $233.38 | $431.25 | $2,726.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $291.08 / $377.83 / $667.76
| Facility | | $291.08 | $377.83 | $667.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.01 / $339.01 / $360.31
| Professional | | $339.01 | $339.01 | $360.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.26 / $223.26 / $223.26
| Facility | | $223.26 | $223.26 | $223.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.16 / $506.46 / $915.73
| Professional | | $280.16 | $506.46 | $915.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $246.11 / $398.09 / $8,090.00
| Facility | | $246.11 | $398.09 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.94 / $424.27 / $585.66
| Professional | | $337.94 | $424.27 | $585.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.69 / $633.41 / $983.74
| Professional | | $302.69 | $633.41 | $983.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,693.68 / $7,161.00
| Facility | | $55.00 | $1,693.68 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.36 / $499.37 / $3,340.19
| Professional | | $330.36 | $499.37 | $3,340.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $700.00 / $2,078.00 / $5,683.00
| Facility | | $700.00 | $2,078.00 | $5,683.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.58 / $431.25 / $953.53
| Professional | | $324.58 | $431.25 | $953.53 |