- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $146.60 / $2,067.00 / $3,625.00
| Facility | | $146.60 | $2,067.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.56 / $178.59 / $470.75
| Professional | | $99.56 | $178.59 | $470.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $272.95 / $620.02 / $2,713.00
| Facility | | $272.95 | $620.02 | $2,713.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.41 / $280.08 / $897.20
| Professional | | $134.41 | $280.08 | $897.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.66 / $188.06 / $331.85
| Facility | | $144.66 | $188.06 | $331.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.81 / $288.74 / $467.60
| Professional | | $164.81 | $288.74 | $467.60 |
- 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
- $141.13 / $253.34 / $524.32
| Professional | | $141.13 | $253.34 | $524.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $124.93 / $214.32 / $6,679.00
| Facility | | $124.93 | $214.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.35 / $272.31 / $375.90
| Professional | | $215.35 | $272.31 | $375.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.13 / $317.14 / $524.32
| Professional | | $151.13 | $317.14 | $524.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.92 / $275.66 / $321.77
| Professional | | $240.92 | $275.66 | $321.77 |
- 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
- $190.21 / $360.80 / $1,400.56
| Professional | | $190.21 | $360.80 | $1,400.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.66 / $204.32 / $412.45
| Professional | | $160.66 | $204.32 | $412.45 |
- 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
- $147.68 / $267.29 / $529.17
| Professional | | $147.68 | $267.29 | $529.17 |