- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $886.00 / $2,663.12 / $3,646.94
| Facility | | $886.00 | $2,663.12 | $3,646.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.92 / $131.37 / $328.30
| Professional | | $101.92 | $131.37 | $328.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.37 / $537.24 / $2,796.00
| Facility | | $213.37 | $537.24 | $2,796.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.48 / $205.96 / $703.68
| Professional | | $105.48 | $205.96 | $703.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.13 / $185.82 / $257.55
| Professional | | $144.13 | $185.82 | $257.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.02 / $204.15 / $357.38
| Professional | | $156.02 | $204.15 | $357.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $96.08 / $205.96 / $8,090.00
| Facility | | $96.08 | $205.96 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.25 / $139.02 / $249.09
| Professional | | $110.25 | $139.02 | $249.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.60 / $237.10 / $306.50
| Professional | | $119.60 | $237.10 | $306.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $334.23 / $947.20 / $4,914.97
| Facility | | $334.23 | $947.20 | $4,914.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.78 / $219.23 / $349.29
| Professional | | $146.78 | $219.23 | $349.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,790.00 / $4,142.00
| Facility | | $55.00 | $1,790.00 | $4,142.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.47 / $225.89 / $703.68
| Professional | | $142.47 | $225.89 | $703.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $2,733.00
| Facility | | $627.00 | $1,818.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.12 / $197.25 / $401.95
| Professional | | $137.12 | $197.25 | $401.95 |