- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $241.92 / $1,788.63 / $4,458.52
| Facility | | $241.92 | $1,788.63 | $4,458.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.23 / $172.22 / $436.87
| Professional | | $103.23 | $172.22 | $436.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $336.38 / $1,878.00 / $7,161.00
| Facility | | $336.38 | $1,878.00 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.01 / $276.33 / $1,000.32
| Professional | | $139.01 | $276.33 | $1,000.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $164.75 / $214.18 / $377.94
| Facility | | $164.75 | $214.18 | $377.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.22 / $304.00 / $433.95
| Professional | | $210.22 | $304.00 | $433.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.01 / $257.64 / $520.35
| Professional | | $154.01 | $257.64 | $520.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.00 / $225.30 / $6,679.00
| Facility | | $141.00 | $225.30 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.77 / $252.72 / $348.85
| Professional | | $199.77 | $252.72 | $348.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.98 / $355.70 / $549.85
| Professional | | $169.98 | $355.70 | $549.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $156.85 / $725.84 / $2,889.08
| Facility | | $156.85 | $725.84 | $2,889.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.74 / $263.47 / $432.11
| Professional | | $141.74 | $263.47 | $432.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $705.85 / $2,078.00 / $11,500.00
| Facility | | $705.85 | $2,078.00 | $11,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.41 / $333.73 / $1,296.16
| Professional | | $188.41 | $333.73 | $1,296.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.00 / $2,408.00 / $5,683.00
| Facility | | $1,106.00 | $2,408.00 | $5,683.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.25 / $250.27 / $491.47
| Professional | | $153.25 | $250.27 | $491.47 |