- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.90 / $1,932.00 / $3,469.00
| Facility | | $226.90 | $1,932.00 | $3,469.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.88 / $209.59 / $484.86
| Professional | | $130.88 | $209.59 | $484.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.60 / $1,089.00 / $5,047.31
| Facility | | $131.60 | $1,089.00 | $5,047.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.32 / $362.78 / $1,560.08
| Professional | | $170.32 | $362.78 | $1,560.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.46 / $208.76 / $372.36
| Facility | | $162.46 | $208.76 | $372.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.09 / $224.73 / $433.57
| Professional | | $138.09 | $224.73 | $433.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $262.49 / $330.49 / $652.29
| Facility | | $262.49 | $330.49 | $652.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.80 / $318.25 / $628.37
| Professional | | $169.80 | $318.25 | $628.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $139.15 / $506.00 / $6,679.00
| Facility | | $139.15 | $506.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.06 / $325.39 / $470.03
| Professional | | $251.06 | $325.39 | $470.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.17 / $371.99 / $589.72
| Professional | | $198.17 | $371.99 | $589.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,640.00 / $4,755.00
| Facility | | $55.00 | $1,640.00 | $4,755.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.95 / $529.66 / $1,560.08
| Professional | | $234.95 | $529.66 | $1,560.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $3,372.00 / $8,459.00
| Facility | | $822.00 | $3,372.00 | $8,459.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.18 / $331.65 / $845.73
| Professional | | $217.18 | $331.65 | $845.73 |