- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.30 / $1,107.68 / $2,900.00
| Facility | | $165.30 | $1,107.68 | $2,900.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.50 / $149.51 / $375.70
| Professional | | $45.50 | $149.51 | $375.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $103.40 / $409.72 / $2,713.00
| Facility | | $103.40 | $409.72 | $2,713.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.09 / $161.56 / $442.32
| Professional | | $50.09 | $161.56 | $442.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.03 / $71.58 / $137.51
| Facility | | $56.03 | $71.58 | $137.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.13 / $133.58 / $299.18
| Professional | | $70.13 | $133.58 | $299.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.60 / $141.74 / $325.48
| Professional | | $52.60 | $141.74 | $325.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.75 / $168.26 / $6,679.00
| Facility | | $54.75 | $168.26 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.68 / $174.44 / $242.40
| Professional | | $137.68 | $174.44 | $242.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.34 / $151.13 / $336.89
| Professional | | $57.34 | $151.13 | $336.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $305.47 / $512.58 / $1,150.97
| Facility | | $305.47 | $512.58 | $1,150.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.16 / $183.11 / $391.37
| Professional | | $139.16 | $183.11 | $391.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $966.90 / $3,445.00
| Facility | | $55.00 | $966.90 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.25 / $206.77 / $885.84
| Professional | | $139.25 | $206.77 | $885.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.53 / $147.11 / $270.36
| Professional | | $108.53 | $147.11 | $270.36 |
- 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
- $122.94 / $183.02 / $346.87
| Professional | | $122.94 | $183.02 | $346.87 |