- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $164.68 / $2,482.50 / $3,625.00
| Facility | | $164.68 | $2,482.50 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.26 / $120.36 / $227.57
| Professional | | $71.26 | $120.36 | $227.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.03 / $627.00 / $2,733.00
| Facility | | $75.03 | $627.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.28 / $198.30 / $524.52
| Professional | | $76.28 | $198.30 | $524.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.34 / $86.54 / $171.74
| Facility | | $67.34 | $86.54 | $171.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.31 / $174.26 / $348.84
| Professional | | $86.31 | $174.26 | $348.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $69.81 / $168.26 / $6,679.00
| Facility | | $69.81 | $168.26 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.30 / $176.03 / $242.99
| Professional | | $145.30 | $176.03 | $242.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.42 / $163.31 / $342.95
| Professional | | $77.42 | $163.31 | $342.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $198.93 / $198.93 / $1,003.41
| Facility | | $198.93 | $198.93 | $1,003.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.37 / $198.93 / $252.61
| Professional | | $106.37 | $198.93 | $252.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $966.90 / $3,445.00
| Facility | | $55.00 | $966.90 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.45 / $276.12 / $1,236.00
| Professional | | $166.45 | $276.12 | $1,236.00 |
- 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
- $149.44 / $233.99 / $409.69
| Professional | | $149.44 | $233.99 | $409.69 |