- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $166.50 / $9,639.00 / $20,509.00
| Facility | | $166.50 | $9,639.00 | $20,509.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.13 / $166.50 / $809.00
| Professional | | $153.13 | $166.50 | $809.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.00 / $5,863.00 / $11,456.00
| Facility | | $2,137.00 | $5,863.00 | $11,456.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.11 / $306.29 / $540.42
| Professional | | $214.11 | $306.29 | $540.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.40 / $100.00 / $10,117.12
| Facility | | $64.40 | $100.00 | $10,117.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.41 / $210.83 / $441.08
| Professional | | $137.41 | $210.83 | $441.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.79 / $200.35 / $483.84
| Professional | | $162.79 | $200.35 | $483.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.55 / $154.13 / $208.08
| Professional | | $148.55 | $154.13 | $208.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.72 / $182.76 / $337.55
| Professional | | $138.72 | $182.76 | $337.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $417.87 / $2,260.00
| Facility | | $55.00 | $417.87 | $2,260.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,622.00 / $2,622.00 / $2,622.00
| Professional | | $2,622.00 | $2,622.00 | $2,622.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $156.69 / $220.38 / $336.00
| Facility | | $156.69 | $220.38 | $336.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.88 / $200.35 / $455.69
| Professional | | $162.88 | $200.35 | $455.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.97 / $501.97 / $501.97
| Professional | | $501.97 | $501.97 | $501.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.02 / $187.33 / $281.00
| Professional | | $147.02 | $187.33 | $281.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $548.00 / $1,523.00 / $6,920.00
| Facility | | $548.00 | $1,523.00 | $6,920.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.72 / $191.88 / $440.80
| Professional | | $135.72 | $191.88 | $440.80 |