- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $185.65 / $2,067.00 / $3,625.00
| Facility | | $185.65 | $2,067.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.71 / $208.47 / $410.05
| Professional | | $134.71 | $208.47 | $410.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.00 / $781.24 / $2,713.00
| Facility | | $308.00 | $781.24 | $2,713.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.41 / $372.87 / $1,248.96
| Professional | | $186.41 | $372.87 | $1,248.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $200.49 / $260.64 / $459.92
| Facility | | $200.49 | $260.64 | $459.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.06 / $397.70 / $608.62
| Professional | | $272.06 | $397.70 | $608.62 |
- 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
- $195.73 / $332.77 / $701.89
| Professional | | $195.73 | $332.77 | $701.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $170.17 / $274.17 / $6,679.00
| Facility | | $170.17 | $274.17 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.70 / $340.67 / $470.25
| Professional | | $270.70 | $340.67 | $470.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.53 / $445.69 / $665.65
| Professional | | $210.53 | $445.69 | $665.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,174.26 / $3,445.00
| Facility | | $55.00 | $1,174.26 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.18 / $460.43 / $1,769.12
| Professional | | $254.18 | $460.43 | $1,769.12 |
- 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
- $230.99 / $355.74 / $839.48
| Professional | | $230.99 | $355.74 | $839.48 |