- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $196.60 / $2,581.76 / $3,625.00
| Facility | | $196.60 | $2,581.76 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.06 / $196.60 / $568.13
| Professional | | $120.06 | $196.60 | $568.13 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,587.00 / $1,587.00 / $1,587.00
| Professional | 50 | $1,587.00 | $1,587.00 | $1,587.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.00 / $953.00 / $2,733.00
| Facility | | $308.00 | $953.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.82 / $372.33 / $1,539.60
| Professional | | $156.82 | $372.33 | $1,539.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.16 / $214.71 / $378.88
| Facility | | $165.16 | $214.71 | $378.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.85 / $270.85 / $431.03
| Professional | | $270.85 | $270.85 | $431.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.93 / $389.95 / $696.84
| Professional | | $201.93 | $389.95 | $696.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.63 / $225.87 / $6,679.00
| Facility | | $140.63 | $225.87 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.79 / $314.37 / $562.08
| Professional | | $248.79 | $314.37 | $562.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.39 / $373.47 / $584.71
| Professional | | $173.39 | $373.47 | $584.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,078.00 / $3,445.00
| Facility | | $55.00 | $1,078.00 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.83 / $586.41 / $1,539.60
| Professional | | $245.83 | $586.41 | $1,539.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $2,733.00
| Facility | | $627.00 | $1,818.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.51 / $345.71 / $804.32
| Professional | | $206.51 | $345.71 | $804.32 |