- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $121.45 / $1,284.00 / $4,083.75
| Facility | | $121.45 | $1,284.00 | $4,083.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.45 / $114.07 / $326.52
| Professional | | $64.45 | $114.07 | $326.52 |
- 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
- $130.40 / $135.32 / $210.55
| Professional | | $130.40 | $135.32 | $210.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.92 / $129.16 / $235.23
| Professional | | $71.92 | $129.16 | $235.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.72 / $202.80 / $209.91
| Professional | | $157.72 | $202.80 | $209.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.20 / $657.74 / $860.89
| Facility | | $213.20 | $657.74 | $860.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.72 / $127.72 / $127.72
| Professional | | $127.72 | $127.72 | $127.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.09 / $1,284.00 / $5,750.00
| Facility | | $194.09 | $1,284.00 | $5,750.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.92 / $123.52 / $360.70
| Professional | | $66.92 | $123.52 | $360.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.37 / $207.60 / $207.60
| Professional | | $74.37 | $207.60 | $207.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.45 / $125.45 / $125.45
| Facility | | $125.45 | $125.45 | $125.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.50 / $130.37 / $263.32
| Professional | | $72.50 | $130.37 | $263.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $71.63 / $126.92 / $176.26
| Facility | | $71.63 | $126.92 | $176.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.63 / $126.92 / $137.34
| Professional | | $71.63 | $126.92 | $137.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $265.18 / $577.00 / $3,742.00
| Facility | | $265.18 | $577.00 | $3,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.45 / $157.06 / $251.72
| Professional | | $115.45 | $157.06 | $251.72 |