- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $142.60 / $2,079.00 / $3,625.00
| Facility | | $142.60 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.70 / $170.55 / $329.25
| Professional | | $98.70 | $170.55 | $329.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.68 / $627.00 / $2,713.00
| Facility | | $270.68 | $627.00 | $2,713.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.33 / $273.41 / $889.60
| Professional | | $133.33 | $273.41 | $889.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.49 / $186.54 / $329.17
| Facility | | $143.49 | $186.54 | $329.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.81 / $286.41 / $455.95
| Professional | | $182.81 | $286.41 | $455.95 |
- 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
- $140.00 / $251.25 / $520.10
| Professional | | $140.00 | $251.25 | $520.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.91 / $214.32 / $6,679.00
| Facility | | $123.91 | $214.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.08 / $265.52 / $366.54
| Professional | | $210.08 | $265.52 | $366.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.91 / $314.56 / $511.65
| Professional | | $149.91 | $314.56 | $511.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.55 / $269.47 / $320.72
| Professional | | $138.55 | $269.47 | $320.72 |
- 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
- $185.00 / $352.12 / $1,366.80
| Professional | | $185.00 | $352.12 | $1,366.80 |
- 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
- $144.49 / $260.70 / $516.98
| Professional | | $144.49 | $260.70 | $516.98 |