- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $172.87 / $1,886.00 / $3,625.00
| Facility | | $172.87 | $1,886.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.65 / $96.40 / $222.72
| Professional | | $29.65 | $96.40 | $222.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.23 / $524.55 / $2,713.00
| Facility | | $70.23 | $524.55 | $2,713.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.19 / $240.16 / $961.20
| Professional | | $36.19 | $240.16 | $961.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.85 / $43.36 / $86.32
| Facility | | $33.85 | $43.36 | $86.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.70 / $165.93 / $331.20
| Professional | | $45.70 | $165.93 | $331.20 |
- 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
- $37.97 / $104.63 / $391.62
| Professional | | $37.97 | $104.63 | $391.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.78 / $83.43 / $8,090.00
| Facility | | $34.78 | $83.43 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.03 / $204.23 / $352.50
| Professional | | $156.03 | $204.23 | $352.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.28 / $139.26 / $376.50
| Professional | | $42.28 | $139.26 | $376.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.01 / $451.35 / $513.44
| Facility | | $213.01 | $451.35 | $513.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.82 / $95.25 / $254.06
| Professional | | $60.82 | $95.25 | $254.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.18 / $953.00 / $2,796.00
| Facility | | $244.18 | $953.00 | $2,796.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.43 / $359.63 / $961.20
| Professional | | $175.43 | $359.63 | $961.20 |
- 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
- $156.63 / $260.67 / $533.46
| Professional | | $156.63 | $260.67 | $533.46 |