- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.08 / $2,747.00 / $4,806.64
| Facility | | $87.08 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.08 / $125.71 / $289.02
| Professional | | $87.08 | $125.71 | $289.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $195.01 / $502.00 / $2,733.00
| Facility | | $195.01 | $502.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.38 / $218.47 / $895.28
| Professional | | $90.38 | $218.47 | $895.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.10 / $137.93 / $243.39
| Facility | | $106.10 | $137.93 | $243.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.65 / $100.65 / $135.69
| Professional | | $100.65 | $100.65 | $135.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.53 / $216.01 / $443.85
| Professional | | $126.53 | $216.01 | $443.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.11 / $276.13 / $6,679.00
| Facility | | $89.11 | $276.13 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.84 / $140.58 / $220.09
| Professional | | $74.84 | $140.58 | $220.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.51 / $241.24 / $331.13
| Professional | | $112.51 | $241.24 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.48 / $203.48 / $203.48
| Professional | | $203.48 | $203.48 | $203.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,078.00 / $3,445.00
| Facility | | $55.00 | $1,078.00 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.62 / $339.93 / $895.28
| Professional | | $141.62 | $339.93 | $895.28 |
- 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
- $129.21 / $193.82 / $415.16
| Professional | | $129.21 | $193.82 | $415.16 |