- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.72 / $2,079.00 / $3,625.00
| Facility | | $151.72 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.78 / $169.75 / $372.89
| Professional | | $100.78 | $169.75 | $372.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $291.45 / $947.00 / $2,713.00
| Facility | | $291.45 | $947.00 | $2,713.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.31 / $311.95 / $2,473.00
| Professional | | $142.31 | $311.95 | $2,473.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $152.94 / $198.84 / $350.87
| Facility | | $152.94 | $198.84 | $350.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.01 / $213.87 / $357.13
| Professional | | $130.01 | $213.87 | $357.13 |
- 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
- $148.51 / $281.05 / $594.42
| Professional | | $148.51 | $281.05 | $594.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.06 / $214.32 / $6,679.00
| Facility | | $132.06 | $214.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.94 / $309.06 / $426.69
| Professional | | $243.94 | $309.06 | $426.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.38 / $342.13 / $621.24
| Professional | | $161.38 | $342.13 | $621.24 |
- 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
- $233.82 / $386.59 / $2,772.20
| Professional | | $233.82 | $386.59 | $2,772.20 |
- 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
- $210.76 / $297.54 / $580.24
| Professional | | $210.76 | $297.54 | $580.24 |