- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $148.96 / $2,079.00 / $3,625.00
| Facility | | $148.96 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.45 / $156.18 / $339.71
| Professional | | $90.45 | $156.18 | $339.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.92 / $1,251.81 / $7,161.00
| Facility | | $300.92 | $1,251.81 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.00 / $288.70 / $889.52
| Professional | | $136.00 | $288.70 | $889.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $145.49 / $189.14 / $333.75
| Facility | | $145.49 | $189.14 | $333.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.65 / $305.47 / $478.58
| Professional | | $185.65 | $305.47 | $478.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.28 / $256.29 / $529.48
| Professional | | $137.28 | $256.29 | $529.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $124.97 / $214.32 / $6,679.00
| Facility | | $124.97 | $214.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.57 / $278.19 / $384.74
| Professional | | $219.57 | $278.19 | $384.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.13 / $320.42 / $581.69
| Professional | | $151.13 | $320.42 | $581.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $522.54 / $522.54 / $522.54
| Facility | | $522.54 | $522.54 | $522.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $622.63 / $2,078.00 / $11,500.00
| Facility | | $622.63 | $2,078.00 | $11,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.80 / $366.14 / $1,419.20
| Professional | | $199.80 | $366.14 | $1,419.20 |
- 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
- $157.26 / $276.60 / $600.09
| Professional | | $157.26 | $276.60 | $600.09 |