- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $241.38 / $2,079.00 / $3,625.00
| Facility | | $241.38 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.69 / $272.81 / $570.94
| Professional | | $220.69 | $272.81 | $570.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.00 / $724.56 / $2,713.00
| Facility | | $308.00 | $724.56 | $2,713.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.54 / $350.10 / $1,562.16
| Professional | | $182.54 | $350.10 | $1,562.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $255.39 / $331.50 / $585.86
| Facility | | $255.39 | $331.50 | $585.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.17 / $456.89 / $613.45
| Professional | | $304.17 | $456.89 | $613.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.57 / $162.57 / $162.57
| Facility | | $162.57 | $162.57 | $162.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.63 / $424.58 / $766.26
| Professional | | $217.63 | $424.58 | $766.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $219.85 / $465.68 / $6,679.00
| Facility | | $219.85 | $465.68 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.89 / $336.86 / $464.99
| Professional | | $268.89 | $336.86 | $464.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.47 / $548.58 / $722.46
| Professional | | $267.47 | $548.58 | $722.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,482.42 / $3,445.00
| Facility | | $55.00 | $1,482.42 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.06 / $418.00 / $1,755.44
| Professional | | $247.06 | $418.00 | $1,755.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $502.00 / $1,790.00 / $2,796.00
| Facility | | $502.00 | $1,790.00 | $2,796.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.47 / $337.49 / $745.24
| Professional | | $241.47 | $337.49 | $745.24 |