- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.92 / $2,079.00 / $3,625.00
| Facility | | $295.92 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.03 / $286.35 / $489.37
| Professional | | $137.03 | $286.35 | $489.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.83 / $1,798.55 / $4,689.00
| Facility | | $293.83 | $1,798.55 | $4,689.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.40 / $367.86 / $1,080.11
| Professional | | $145.40 | $367.86 | $1,080.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $155.72 / $202.44 / $397.09
| Facility | | $155.72 | $202.44 | $397.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $586.22 / $586.22 / $586.22
| Professional | | $586.22 | $586.22 | $586.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.20 / $288.20 / $288.20
| Facility | | $288.20 | $288.20 | $288.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.03 / $390.00 / $806.71
| Professional | | $188.03 | $390.00 | $806.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $133.72 / $214.32 / $6,679.00
| Facility | | $133.72 | $214.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.01 / $411.78 / $573.54
| Professional | | $325.01 | $411.78 | $573.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.97 / $356.55 / $902.34
| Professional | | $160.97 | $356.55 | $902.34 |
- 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
- $314.52 / $546.16 / $2,951.46
| Professional | | $314.52 | $546.16 | $2,951.46 |
- 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
- $294.29 / $433.94 / $910.12
| Professional | | $294.29 | $433.94 | $910.12 |