- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.33 / $2,067.00 / $3,625.00
| Facility | | $115.33 | $2,067.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.81 / $118.31 / $264.52
| Professional | | $83.81 | $118.31 | $264.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $196.65 / $406.37 / $2,713.00
| Facility | | $196.65 | $406.37 | $2,713.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.97 / $205.26 / $902.64
| Professional | | $94.97 | $205.26 | $902.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $96.62 / $125.61 / $221.65
| Facility | | $96.62 | $125.61 | $221.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.65 / $177.79 / $399.32
| Professional | | $91.65 | $177.79 | $399.32 |
- 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
- $118.56 / $209.21 / $390.53
| Professional | | $118.56 | $209.21 | $390.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $84.29 / $176.18 / $6,679.00
| Facility | | $84.29 | $176.18 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.09 / $143.66 / $231.60
| Professional | | $78.09 | $143.66 | $231.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.22 / $228.71 / $342.04
| Professional | | $106.22 | $228.71 | $342.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.18 / $325.76 / $395.46
| Facility | | $293.18 | $325.76 | $395.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.30 / $132.05 / $258.33
| Professional | | $66.30 | $132.05 | $258.33 |
- 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
- $148.58 / $312.27 / $902.64
| Professional | | $148.58 | $312.27 | $902.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $3,445.00
| Facility | | $627.00 | $1,818.00 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.76 / $186.91 / $381.27
| Professional | | $145.76 | $186.91 | $381.27 |