- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $219.48 / $2,079.00 / $3,625.00
| Facility | | $219.48 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.08 / $216.02 / $353.02
| Professional | | $136.08 | $216.02 | $353.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.60 / $1,798.55 / $4,689.00
| Facility | | $295.60 | $1,798.55 | $4,689.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.19 / $297.18 / $957.04
| Professional | | $145.19 | $297.18 | $957.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $156.04 / $202.85 / $357.96
| Facility | | $156.04 | $202.85 | $357.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.50 / $339.50 / $541.89
| Professional | | $232.50 | $339.50 | $541.89 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $879.33 / $879.33 / $879.33
| Professional | 50 | $879.33 | $879.33 | $879.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $191.42 / $191.42 / $191.42
| Facility | | $191.42 | $191.42 | $191.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.02 / $317.83 / $582.69
| Professional | | $168.02 | $317.83 | $582.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.00 / $214.32 / $6,679.00
| Facility | | $134.00 | $214.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.83 / $302.60 / $418.70
| Professional | | $238.83 | $302.60 | $418.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.38 / $354.68 / $686.59
| Professional | | $161.38 | $354.68 | $686.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.00 / $188.00 / $532.72
| Professional | | $188.00 | $188.00 | $532.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,338.00 / $8,498.00
| Facility | | $55.00 | $2,338.00 | $8,498.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.35 / $406.16 / $2,357.73
| Professional | | $224.35 | $406.16 | $2,357.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,245.00 / $3,592.00 / $8,459.00
| Facility | | $1,245.00 | $3,592.00 | $8,459.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.58 / $303.01 / $655.11
| Professional | | $216.58 | $303.01 | $655.11 |