- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $239.88 / $12,022.64
| Facility | | $100.00 | $239.88 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $251.19 / $891.25
| Professional | | $95.50 | $251.19 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $416.87 / $2,570.40
| Facility | | $138.04 | $416.87 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $165.96 / $1,258.93
| Professional | | $131.83 | $165.96 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $173.78 / $275.42
| Facility | | $100.00 | $173.78 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $199.53 / $204.17
| Professional | | $117.49 | $199.53 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.13 / $831.76 / $2,041.74
| Facility | | $74.13 | $831.76 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $154.88 / $436.52
| Professional | | $83.18 | $154.88 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.70 / $107.15 / $154.88
| Professional | | $25.70 | $107.15 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $537.03 / $891.25
| Professional | | $141.25 | $537.03 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $11,220.18 / $11,220.18
| Facility | | $11,220.18 | $11,220.18 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $851.14
| Professional | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $416.87 / $2,570.40
| Facility | | $138.04 | $416.87 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $177.83 / $1,258.93
| Professional | | $131.83 | $177.83 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $158.49 / $288.40
| Facility | | $100.00 | $158.49 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $177.83 / $891.25
| Professional | | $53.70 | $177.83 | $891.25 |