- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.26 / $2,747.00 / $4,806.64
| Facility | | $74.26 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.26 / $142.49 / $307.45
| Professional | | $74.26 | $142.49 | $307.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $210.89 / $679.46 / $2,713.00
| Facility | | $210.89 | $679.46 | $2,713.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.97 / $248.25 / $695.92
| Professional | | $102.97 | $248.25 | $695.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.29 / $143.38 / $280.87
| Facility | | $110.29 | $143.38 | $280.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.63 / $248.10 / $452.16
| Professional | | $154.63 | $248.10 | $452.16 |
- 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
- $108.12 / $221.26 / $483.89
| Professional | | $108.12 | $221.26 | $483.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $94.22 / $295.56 / $6,679.00
| Facility | | $94.22 | $295.56 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.06 / $253.10 / $349.38
| Professional | | $200.06 | $253.10 | $349.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.15 / $254.10 / $492.10
| Professional | | $117.15 | $254.10 | $492.10 |
- 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
- $170.02 / $351.87 / $1,299.52
| Professional | | $170.02 | $351.87 | $1,299.52 |
- 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
- $132.32 / $246.81 / $494.81
| Professional | | $132.32 | $246.81 | $494.81 |