- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $373.76 / $1,803.00 / $4,088.00
| Facility | | $373.76 | $1,803.00 | $4,088.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.74 / $236.10 / $686.08
| Professional | | $141.74 | $236.10 | $686.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.23 / $612.10 / $2,713.00
| Facility | | $226.23 | $612.10 | $2,713.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.40 / $235.28 / $739.76
| Professional | | $107.40 | $235.28 | $739.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.49 / $152.74 / $269.52
| Facility | | $117.49 | $152.74 | $269.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.96 / $185.63 / $326.58
| Professional | | $24.96 | $185.63 | $326.58 |
- 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
- $147.31 / $235.51 / $540.44
| Professional | | $147.31 | $235.51 | $540.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.78 / $300.00 / $6,679.00
| Facility | | $102.78 | $300.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.94 / $193.35 / $266.89
| Professional | | $154.94 | $193.35 | $266.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.98 / $264.60 / $386.48
| Professional | | $126.98 | $264.60 | $386.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $374.04 / $453.49 / $3,201.54
| Facility | | $374.04 | $453.49 | $3,201.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.09 / $315.42 / $452.82
| Professional | | $209.09 | $315.42 | $452.82 |
- 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
- $179.72 / $318.33 / $1,346.74
| Professional | | $179.72 | $318.33 | $1,346.74 |
- 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
- $157.26 / $236.46 / $429.68
| Professional | | $157.26 | $236.46 | $429.68 |