- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $82.91 / $2,740.50 / $5,540.26
| Facility | | $82.91 | $2,740.50 | $5,540.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.91 / $154.43 / $568.57
| Professional | | $82.91 | $154.43 | $568.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.37 / $2,628.00 / $7,619.68
| Facility | | $223.37 | $2,628.00 | $7,619.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.05 / $202.27 / $1,500.00
| Professional | | $109.05 | $202.27 | $1,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.43 / $190.59 / $328.58
| Professional | | $138.43 | $190.59 | $328.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.77 / $206.04 / $401.95
| Professional | | $114.77 | $206.04 | $401.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.14 / $300.00 / $6,679.00
| Facility | | $101.14 | $300.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.11 / $113.79 / $183.45
| Professional | | $61.11 | $113.79 | $183.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.57 / $252.43 / $383.25
| Professional | | $126.57 | $252.43 | $383.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.91 / $2,903.38 / $3,949.81
| Facility | | $1,350.91 | $2,903.38 | $3,949.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.75 / $166.03 / $298.86
| Professional | | $75.75 | $166.03 | $298.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $3,715.00 / $9,496.40
| Facility | | $55.00 | $3,715.00 | $9,496.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.98 / $215.33 / $1,500.00
| Professional | | $123.98 | $215.33 | $1,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.90 / $156.12 / $333.30
| Professional | | $116.90 | $156.12 | $333.30 |