- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.00 / $566.67 / $3,625.00
| Facility | | $120.00 | $566.67 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.02 / $196.64 / $809.00
| Professional | | $102.02 | $196.64 | $809.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $232.25 / $502.00 / $2,733.00
| Facility | | $232.25 | $502.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.01 / $343.53 / $1,483.12
| Professional | | $144.01 | $343.53 | $1,483.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.72 / $192.04 / $338.87
| Facility | | $147.72 | $192.04 | $338.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.66 / $243.00 / $556.09
| Professional | | $117.66 | $243.00 | $556.09 |
- 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
- $192.95 / $353.88 / $615.90
| Professional | | $192.95 | $353.88 | $615.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.14 / $214.32 / $6,679.00
| Facility | | $125.14 | $214.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.81 / $304.30 / $544.05
| Professional | | $240.81 | $304.30 | $544.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.87 / $329.47 / $562.50
| Professional | | $150.87 | $329.47 | $562.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.42 / $89.42 / $105.90
| Facility | | $89.42 | $89.42 | $105.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.86 / $194.93 / $523.04
| Professional | | $157.86 | $194.93 | $523.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,078.00 / $3,445.00
| Facility | | $55.00 | $1,078.00 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.04 / $531.02 / $1,483.12
| Professional | | $238.04 | $531.02 | $1,483.12 |
- 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
- $224.49 / $339.39 / $677.66
| Professional | | $224.49 | $339.39 | $677.66 |