- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.99 / $2,067.00 / $3,625.00
| Facility | | $131.99 | $2,067.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.99 / $130.72 / $289.23
| Professional | | $63.99 | $130.72 | $289.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.65 / $679.46 / $2,713.00
| Facility | | $208.65 | $679.46 | $2,713.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.71 / $238.73 / $686.16
| Professional | | $89.71 | $238.73 | $686.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $111.98 / $145.57 / $260.58
| Facility | | $111.98 | $145.57 | $260.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.58 / $187.21 / $337.68
| Professional | | $127.58 | $187.21 | $337.68 |
- 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
- $116.08 / $238.63 / $490.64
| Professional | | $116.08 | $238.63 | $490.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $96.07 / $204.18 / $6,679.00
| Facility | | $96.07 | $204.18 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.48 / $233.73 / $324.14
| Professional | | $184.48 | $233.73 | $324.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.51 / $244.53 / $448.18
| Professional | | $115.51 | $244.53 | $448.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.91 / $268.52 / $283.63
| Facility | | $140.91 | $268.52 | $283.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.23 / $291.23 / $291.23
| Professional | | $291.23 | $291.23 | $291.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $966.90 / $3,445.00
| Facility | | $55.00 | $966.90 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.61 / $317.00 / $1,191.92
| Professional | | $103.61 | $317.00 | $1,191.92 |
- 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
- $100.45 / $238.73 / $441.42
| Professional | | $100.45 | $238.73 | $441.42 |