- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.66 / $1,791.65 / $5,526.00
| Facility | | $158.66 | $1,791.65 | $5,526.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.21 / $127.29 / $377.40
| Professional | | $83.21 | $127.29 | $377.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.69 / $3,159.00 / $14,886.03
| Facility | | $2,344.69 | $3,159.00 | $14,886.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.67 / $179.35 / $228.82
| Professional | | $110.67 | $179.35 | $228.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.15 / $143.74 / $226.55
| Professional | | $96.15 | $143.74 | $226.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.71 / $200.71 / $203.01
| Professional | | $200.71 | $200.71 | $203.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $379.52 / $1,851.00 / $3,452.07
| Facility | | $379.52 | $1,851.00 | $3,452.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.66 / $1,739.52 / $5,868.00
| Facility | | $158.66 | $1,739.52 | $5,868.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.21 / $142.80 / $420.80
| Professional | | $83.21 | $142.80 | $420.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.10 / $151.00 / $348.60
| Professional | | $146.10 | $151.00 | $348.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.15 / $145.47 / $219.58
| Professional | | $96.15 | $145.47 | $219.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.72 / $99.40 / $146.16
| Facility | | $83.72 | $99.40 | $146.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.72 / $99.40 / $136.25
| Professional | | $83.72 | $99.40 | $136.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $435.00 / $1,305.00 / $3,742.00
| Facility | | $435.00 | $1,305.00 | $3,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.24 / $165.66 / $261.42
| Professional | | $128.24 | $165.66 | $261.42 |