- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.65 / $1,234.00 / $6,012.00
| Facility | | $93.65 | $1,234.00 | $6,012.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.95 / $93.65 / $185.84
| Professional | | $48.95 | $93.65 | $185.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.82 / $169.13 / $169.13
| Professional | | $134.82 | $169.13 | $169.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,083.51 / $1,395.00 / $12,759.45
| Facility | | $1,083.51 | $1,395.00 | $12,759.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.56 / $102.28 / $288.51
| Professional | | $98.56 | $102.28 | $288.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.23 / $118.21 / $216.79
| Professional | | $64.23 | $118.21 | $216.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.56 / $157.31 / $159.80
| Professional | | $118.56 | $157.31 | $159.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.85 / $843.90 / $1,790.81
| Facility | | $281.85 | $843.90 | $1,790.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.51 / $146.51 / $146.51
| Professional | | $146.51 | $146.51 | $146.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.00 / $1,819.00 / $7,197.00
| Facility | | $490.00 | $1,819.00 | $7,197.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.75 / $118.37 / $274.32
| Professional | | $53.75 | $118.37 | $274.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $105.40 / $340.70
| Professional | | $3.00 | $105.40 | $340.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.03 / $118.21 / $220.74
| Professional | | $65.03 | $118.21 | $220.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.75 / $90.05 / $139.24
| Facility | | $53.75 | $90.05 | $139.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.75 / $96.66 / $105.56
| Professional | | $53.75 | $96.66 | $105.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.00 / $577.00 / $3,742.00
| Facility | | $162.00 | $577.00 | $3,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.42 / $132.22 / $206.74
| Professional | | $87.42 | $132.22 | $206.74 |