- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.99 / $2,079.00 / $3,625.00
| Facility | | $190.99 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.46 / $190.99 / $312.01
| Professional | | $132.46 | $190.99 | $312.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $327.32 / $2,376.00 / $8,498.00
| Facility | | $327.32 | $2,376.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.02 / $268.12 / $953.68
| Professional | | $146.02 | $268.12 | $953.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $156.06 / $202.88 / $358.00
| Facility | | $156.06 | $202.88 | $358.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.57 / $335.02 / $516.03
| Professional | | $224.57 | $335.02 | $516.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,593.42 / $1,593.42 / $1,593.42
| Facility | | $1,593.42 | $1,593.42 | $1,593.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.27 / $286.76 / $525.41
| Professional | | $157.27 | $286.76 | $525.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $133.69 / $300.00 / $6,679.00
| Facility | | $133.69 | $300.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.29 / $275.30 / $380.56
| Professional | | $217.29 | $275.30 | $380.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.56 / $350.02 / $624.49
| Professional | | $160.56 | $350.02 | $624.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.82 / $318.82 / $318.82
| Professional | | $318.82 | $318.82 | $318.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $898.26 / $3,372.00 / $12,000.00
| Facility | | $898.26 | $3,372.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.35 / $308.80 / $1,409.36
| Professional | | $202.35 | $308.80 | $1,409.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,245.00 / $3,372.00 / $8,425.00
| Facility | | $1,245.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.80 / $271.27 / $597.07
| Professional | | $189.80 | $271.27 | $597.07 |