- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $241.78 / $2,079.00 / $3,625.00
| Facility | | $241.78 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.56 / $241.78 / $414.79
| Professional | | $167.56 | $241.78 | $414.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.00 / $716.81 / $2,713.00
| Facility | | $308.00 | $716.81 | $2,713.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.79 / $362.16 / $1,200.72
| Professional | | $183.79 | $362.16 | $1,200.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $196.05 / $254.87 / $449.74
| Facility | | $196.05 | $254.87 | $449.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.88 / $205.88 / $205.88
| Professional | | $205.88 | $205.88 | $205.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $210.10 / $210.10 / $210.10
| Facility | | $210.10 | $210.10 | $210.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.26 / $389.57 / $702.20
| Professional | | $185.26 | $389.57 | $702.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $168.12 / $357.48 / $6,679.00
| Facility | | $168.12 | $357.48 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.27 / $361.44 / $499.93
| Professional | | $285.27 | $361.44 | $499.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.93 / $443.80 / $720.06
| Professional | | $201.93 | $443.80 | $720.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $409.24 / $409.24 / $409.24
| Professional | | $409.24 | $409.24 | $409.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,130.09 / $3,445.00
| Facility | | $55.00 | $1,130.09 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.27 / $448.77 / $2,342.56
| Professional | | $269.27 | $448.77 | $2,342.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $1,790.00 / $2,733.00
| Facility | | $500.00 | $1,790.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.69 / $355.49 / $747.84
| Professional | | $242.69 | $355.49 | $747.84 |