- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $276.00 / $2,663.12 / $3,625.00
| Facility | | $276.00 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.04 / $270.81 / $429.68
| Professional | | $139.04 | $270.81 | $429.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $342.90 / $1,798.55 / $8,498.00
| Facility | | $342.90 | $1,798.55 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.53 / $365.67 / $998.96
| Professional | | $152.53 | $365.67 | $998.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $163.31 / $212.30 / $416.44
| Facility | | $163.31 | $212.30 | $416.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.61 / $362.79 / $647.24
| Professional | | $221.61 | $362.79 | $647.24 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $879.33 / $879.33 / $908.82
| Professional | 50 | $879.33 | $879.33 | $908.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $650.80 / $650.80 / $650.80
| Facility | | $650.80 | $650.80 | $650.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.09 / $381.31 / $729.99
| Professional | | $192.09 | $381.31 | $729.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.03 / $300.00 / $6,679.00
| Facility | | $140.03 | $300.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.42 / $374.29 / $520.30
| Professional | | $295.42 | $374.29 | $520.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.35 / $371.68 / $846.19
| Professional | | $168.35 | $371.68 | $846.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.16 / $3,372.00 / $16,394.00
| Facility | | $941.16 | $3,372.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.75 / $506.98 / $2,972.32
| Professional | | $288.75 | $506.98 | $2,972.32 |
- 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
- $269.42 / $384.58 / $790.58
| Professional | | $269.42 | $384.58 | $790.58 |