- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.99 / $1,823.00 / $3,363.00
| Facility | | $115.99 | $1,823.00 | $3,363.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.83 / $142.33 / $231.50
| Professional | | $101.83 | $142.33 | $231.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $741.90 / $2,391.00
| Facility | | $75.00 | $741.90 | $2,391.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.34 / $267.89 / $1,070.88
| Professional | | $125.34 | $267.89 | $1,070.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.88 / $165.61 / $295.39
| Facility | | $128.88 | $165.61 | $295.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.73 / $353.73 / $353.73
| Professional | | $353.73 | $353.73 | $353.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $168.14 / $211.69 / $500.00
| Facility | | $168.14 | $211.69 | $500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.31 / $231.50 / $470.54
| Professional | | $133.31 | $231.50 | $470.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.42 / $377.00 / $6,679.00
| Facility | | $110.42 | $377.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.47 / $221.35 / $355.88
| Professional | | $171.47 | $221.35 | $355.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.93 / $292.57 / $403.73
| Professional | | $154.93 | $292.57 | $403.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $741.90 / $2,733.00
| Facility | | $55.00 | $741.90 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.55 / $381.61 / $1,070.88
| Professional | | $184.55 | $381.61 | $1,070.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.00 / $1,078.00 / $2,733.00
| Facility | | $308.00 | $1,078.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.22 / $239.88 / $533.20
| Professional | | $162.22 | $239.88 | $533.20 |