- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $146.83 / $199.51 / $7,090.00
| Facility | | $146.83 | $199.51 | $7,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.01 / $150.65 / $231.75
| Professional | | $120.01 | $150.65 | $231.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.19 / $138.08 / $285.83
| Professional | | $111.19 | $138.08 | $285.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.21 / $63.21 / $153.16
| Facility | | $63.21 | $63.21 | $153.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.21 / $153.16 / $216.37
| Professional | | $63.21 | $153.16 | $216.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $73.75 / $99.75 / $151.37
| Facility | | $73.75 | $99.75 | $151.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.35 / $229.25 / $495.17
| Professional | | $111.35 | $229.25 | $495.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $98.64 / $201.45 / $346.00
| Facility | | $98.64 | $201.45 | $346.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.12 / $187.15 / $263.22
| Professional | | $152.12 | $187.15 | $263.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.60 / $169.82 / $319.38
| Professional | | $117.60 | $169.82 | $319.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.54 / $245.54 / $245.54
| Facility | | $245.54 | $245.54 | $245.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.74 / $555.00 / $3,792.00
| Facility | | $97.74 | $555.00 | $3,792.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.25 / $214.35 / $447.30
| Professional | | $126.25 | $214.35 | $447.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.09 / $168.91 / $524.42
| Professional | | $122.09 | $168.91 | $524.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.51 / $157.51 / $157.51
| Facility | | $157.51 | $157.51 | $157.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.88 / $175.28 / $344.31
| Professional | | $133.88 | $175.28 | $344.31 |