- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.01 / $3,445.00 / $10,893.00
| Facility | | $87.01 | $3,445.00 | $10,893.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.57 / $87.51 / $141.18
| Professional | | $63.57 | $87.51 | $141.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.71 / $92.34 / $154.06
| Professional | | $63.71 | $92.34 | $154.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65.23 / $65.23 / $80.00
| Facility | | $65.23 | $65.23 | $80.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $118.61 / $118.61 / $118.61
| Facility | | $118.61 | $118.61 | $118.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.67 / $110.31 / $175.10
| Professional | | $74.67 | $110.31 | $175.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $357.87
| Facility | | $55.00 | $55.00 | $357.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $508.16 / $744.40 / $885.00
| Professional | | $508.16 | $744.40 | $885.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.93 / $99.57 / $152.81
| Facility | | $66.93 | $99.57 | $152.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.99 / $128.75 / $180.71
| Professional | | $89.99 | $128.75 | $180.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.50 / $107.50 / $107.50
| Professional | | $107.50 | $107.50 | $107.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.93 / $99.97 / $156.41
| Facility | | $66.93 | $99.97 | $156.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.72 / $115.54 / $190.29
| Professional | | $75.72 | $115.54 | $190.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $161.00 / $950.00 / $2,405.00
| Facility | | $161.00 | $950.00 | $2,405.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.52 / $100.69 / $156.07
| Professional | | $75.52 | $100.69 | $156.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.41 / $97.20 / $136.77
| Professional | | $86.41 | $97.20 | $136.77 |