- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.69 / $2,079.00 / $3,625.00
| Facility | | $125.69 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.92 / $149.63 / $405.62
| Professional | | $84.92 | $149.63 | $405.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $236.23 / $627.00 / $2,713.00
| Facility | | $236.23 | $627.00 | $2,713.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.95 / $239.18 / $774.08
| Professional | | $115.95 | $239.18 | $774.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.29 / $162.88 / $287.42
| Facility | | $125.29 | $162.88 | $287.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.22 / $230.80 / $404.35
| Professional | | $149.22 | $230.80 | $404.35 |
- 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
- $121.65 / $219.43 / $450.60
| Professional | | $121.65 | $219.43 | $450.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.04 / $214.32 / $6,679.00
| Facility | | $108.04 | $214.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.06 / $235.48 / $325.05
| Professional | | $186.06 | $235.48 | $325.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.66 / $276.61 / $454.54
| Professional | | $130.66 | $276.61 | $454.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.17 / $244.47 / $304.18
| Professional | | $202.17 | $244.47 | $304.18 |
- 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
- $161.85 / $308.60 / $1,208.32
| Professional | | $161.85 | $308.60 | $1,208.32 |
- 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
- $150.41 / $228.49 / $457.10
| Professional | | $150.41 | $228.49 | $457.10 |