- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $1,905.46 / $3,715.35
| Facility | | $128.82 | $1,905.46 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $158.49 / $398.11
| Professional | | $102.33 | $158.49 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $1,000.00 / $13,489.63
| Facility | | $239.88 | $1,000.00 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $169.82 / $407.38
| Professional | | $97.72 | $169.82 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $120.23 / $275.42
| Facility | | $120.23 | $120.23 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $208.93 / $288.40
| Professional | | $120.23 | $208.93 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $213.80 / $389.05
| Professional | | $107.15 | $213.80 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.13 / $190.55 / $7,079.46
| Facility | | $89.13 | $190.55 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $190.55 / $257.04
| Professional | | $147.91 | $190.55 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,862.09 / $3,467.37
| Facility | | $501.19 | $1,862.09 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $169.82 / $346.74
| Professional | | $104.71 | $169.82 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $3,890.45 / $3,890.45
| Facility | | $3,890.45 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $208.93 / $239.88
| Professional | | $181.97 | $208.93 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $1,023.29 / $13,489.63
| Facility | | $239.88 | $1,023.29 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $169.82 / $398.11
| Professional | | $97.72 | $169.82 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,819.70 / $2,818.38
| Facility | | $501.19 | $1,819.70 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $169.82 / $346.74
| Professional | | $104.71 | $169.82 | $346.74 |