- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $171.65 / $610.62 / $4,798.60
| Facility | | $171.65 | $610.62 | $4,798.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.23 / $141.97 / $311.08
| Professional | | $93.23 | $141.97 | $311.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.26 / $333.26 / $333.26
| Professional | | $333.26 | $333.26 | $333.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,083.51 / $1,395.00 / $5,044.89
| Facility | | $1,083.51 | $1,395.00 | $5,044.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.59 / $186.12 / $313.33
| Professional | | $170.59 | $186.12 | $313.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.08 / $169.68 / $292.26
| Professional | | $107.08 | $169.68 | $292.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.05 / $289.58 / $295.12
| Professional | | $218.05 | $289.58 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $317.85 / $550.67 / $1,147.41
| Facility | | $317.85 | $550.67 | $1,147.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $172.26 / $1,246.00 / $5,627.00
| Facility | | $172.26 | $1,246.00 | $5,627.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.72 / $172.98 / $367.35
| Professional | | $96.72 | $172.98 | $367.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $162.19 / $505.10
| Professional | | $3.00 | $162.19 | $505.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.87 / $169.90 / $297.26
| Professional | | $111.87 | $169.90 | $297.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.07 / $108.96 / $181.04
| Facility | | $101.07 | $108.96 | $181.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.99 / $140.91 / $195.11
| Professional | | $105.99 | $140.91 | $195.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.00 / $577.00 / $3,742.00
| Facility | | $162.00 | $577.00 | $3,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.44 / $177.84 / $309.64
| Professional | | $131.44 | $177.84 | $309.64 |