- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $149.97 / $2,079.00 / $3,625.00
| Facility | | $149.97 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.12 / $149.97 / $325.44
| Professional | | $84.12 | $149.97 | $325.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $253.55 / $627.00 / $2,733.00
| Facility | | $253.55 | $627.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.39 / $298.20 / $1,330.32
| Professional | | $126.39 | $298.20 | $1,330.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.38 / $174.69 / $308.27
| Facility | | $134.38 | $174.69 | $308.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.37 / $220.37 / $372.88
| Professional | | $220.37 | $220.37 | $372.88 |
- 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
- $172.34 / $315.19 / $597.71
| Professional | | $172.34 | $315.19 | $597.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.47 / $300.00 / $6,679.00
| Facility | | $114.47 | $300.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.03 / $271.72 / $476.18
| Professional | | $215.03 | $271.72 | $476.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.07 / $303.86 / $503.54
| Professional | | $141.07 | $303.86 | $503.54 |
- 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
- $214.19 / $466.27 / $1,330.32
| Professional | | $214.19 | $466.27 | $1,330.32 |
- 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
- $202.71 / $286.50 / $603.29
| Professional | | $202.71 | $286.50 | $603.29 |