- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.82 / $988.00 / $3,685.00
| Facility | | $151.82 | $988.00 | $3,685.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.66 / $177.44 / $470.86
| Professional | | $82.66 | $177.44 | $470.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.22 / $679.46 / $2,713.00
| Facility | | $239.22 | $679.46 | $2,713.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.64 / $235.02 / $771.12
| Professional | | $117.64 | $235.02 | $771.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $127.58 / $165.85 / $292.67
| Facility | | $127.58 | $165.85 | $292.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.24 / $250.92 / $384.00
| Professional | | $166.24 | $250.92 | $384.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $50.00 / $50.00
| Facility | | $50.00 | $50.00 | $50.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.97 / $234.75 / $471.85
| Professional | | $131.97 | $234.75 | $471.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.94 / $214.32 / $6,679.00
| Facility | | $108.94 | $214.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.21 / $214.38 / $296.70
| Professional | | $169.21 | $214.38 | $296.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.07 / $277.48 / $447.85
| Professional | | $131.07 | $277.48 | $447.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.10 / $287.97 / $3,138.79
| Facility | | $158.10 | $287.97 | $3,138.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.58 / $223.00 / $479.12
| Professional | | $127.58 | $223.00 | $479.12 |
- 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
- $149.82 / $290.76 / $1,093.20
| Professional | | $149.82 | $290.76 | $1,093.20 |
- 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
- $133.97 / $213.04 / $420.19
| Professional | | $133.97 | $213.04 | $420.19 |