- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.91 / $2,124.00 / $7,513.00
| Facility | | $157.91 | $2,124.00 | $7,513.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.87 / $111.71 / $187.41
| Professional | | $79.87 | $111.71 | $187.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.10 / $100.17 / $369.85
| Facility | | $57.10 | $100.17 | $369.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.30 / $115.10 / $163.87
| Professional | | $82.30 | $115.10 | $163.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $81.55 / $81.87
| Facility | | $80.00 | $81.55 | $81.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $152.74 / $152.74 / $152.74
| Facility | | $152.74 | $152.74 | $152.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.98 / $137.08 / $225.00
| Professional | | $94.98 | $137.08 | $225.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $460.37
| Facility | | $55.00 | $55.00 | $460.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $661.44 / $1,059.75 / $1,490.91
| Professional | | $661.44 | $1,059.75 | $1,490.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $88.49 / $133.79 / $252.41
| Facility | | $88.49 | $133.79 | $252.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.00 / $155.10 / $220.66
| Professional | | $113.00 | $155.10 | $220.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.49 / $122.39 / $156.29
| Professional | | $88.49 | $122.39 | $156.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $88.49 / $134.37 / $252.41
| Facility | | $88.49 | $134.37 | $252.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.02 / $141.41 / $229.15
| Professional | | $96.02 | $141.41 | $229.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $600.00 / $2,100.00 / $4,554.00
| Facility | | $600.00 | $2,100.00 | $4,554.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.97 / $118.70 / $197.75
| Professional | | $87.97 | $118.70 | $197.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.63 / $118.07 / $165.97
| Professional | | $104.63 | $118.07 | $165.97 |