- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $2,238.72 / $3,801.89
| Facility | | $151.36 | $2,238.72 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $288.40 / $724.44
| Professional | | $138.04 | $288.40 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,288.25 / $4,073.80
| Facility | | $56.23 | $1,288.25 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $295.12 / $758.58
| Professional | | $173.78 | $295.12 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $199.53 / $457.09
| Facility | | $199.53 | $199.53 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $457.09 / $891.25
| Professional | | $263.03 | $457.09 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $331.13 / $660.69
| Professional | | $194.98 | $331.13 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $302.00 / $8,511.38
| Facility | | $158.49 | $302.00 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $257.04 / $426.58
| Professional | | $154.88 | $257.04 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,311.31 / $5,888.44
| Facility | | $1,000.00 | $3,311.31 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $323.59 / $660.69
| Professional | | $194.98 | $323.59 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $389.05 / $467.74
| Professional | | $338.84 | $389.05 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $1,288.25 / $4,073.80
| Facility | | $56.23 | $1,288.25 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $288.40 / $758.58
| Professional | | $165.96 | $288.40 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $2,754.23 / $4,677.35
| Facility | | $162.18 | $2,754.23 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $295.12 / $630.96
| Professional | | $158.49 | $295.12 | $630.96 |