- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $240.34 / $1,741.00 / $7,175.00
| Facility | | $240.34 | $1,741.00 | $7,175.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.34 / $101.05 / $188.87
| Professional | | $70.34 | $101.05 | $188.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,299.82 / $2,746.00 / $13,822.74
| Facility | | $2,299.82 | $2,746.00 | $13,822.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.42 / $153.66 / $190.54
| Professional | | $115.42 | $153.66 | $190.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.76 / $131.76 / $131.76
| Facility | | $131.76 | $131.76 | $131.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.97 / $117.66 / $199.16
| Professional | | $80.97 | $117.66 | $199.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.08 / $186.70 / $240.24
| Professional | | $139.08 | $186.70 | $240.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.00 / $45.00 / $45.00
| Facility | | $45.00 | $45.00 | $45.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.63 / $118.94 / $148.33
| Professional | | $104.63 | $118.94 | $148.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $536.00 / $2,266.00 / $8,017.00
| Facility | | $536.00 | $2,266.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.68 / $114.39 / $254.37
| Professional | | $72.68 | $114.39 | $254.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.00 / $182.80 / $312.80
| Professional | | $112.00 | $182.80 | $312.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.76 / $131.76 / $131.76
| Facility | | $131.76 | $131.76 | $131.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.59 / $120.27 / $202.25
| Professional | | $80.59 | $120.27 | $202.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.73 / $76.52 / $114.14
| Facility | | $66.73 | $76.52 | $114.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.47 / $87.25 / $123.02
| Professional | | $74.47 | $87.25 | $123.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.00 / $650.00 / $3,742.00
| Facility | | $162.00 | $650.00 | $3,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.31 / $131.99 / $207.98
| Professional | | $101.31 | $131.99 | $207.98 |