- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $242.85 / $525.08 / $1,215.00
| Facility | | $242.85 | $525.08 | $1,215.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.86 / $102.51 / $341.18
| Professional | | $63.86 | $102.51 | $341.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $113.82 / $512.58 / $2,713.00
| Facility | | $113.82 | $512.58 | $2,713.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.88 / $158.44 / $720.00
| Professional | | $75.88 | $158.44 | $720.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.83 / $105.15 / $187.72
| Facility | | $81.83 | $105.15 | $187.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.42 / $154.19 / $243.01
| Professional | | $104.42 | $154.19 | $243.01 |
- 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
- $85.32 / $142.87 / $268.02
| Professional | | $85.32 | $142.87 | $268.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.84 / $300.00 / $6,679.00
| Facility | | $81.84 | $300.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.94 / $141.46 / $195.36
| Professional | | $115.94 | $141.46 | $195.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.46 / $187.31 / $284.48
| Professional | | $89.46 | $187.31 | $284.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $222.61 / $222.61 / $509.15
| Facility | | $222.61 | $222.61 | $509.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.98 / $138.02 / $198.33
| Professional | | $127.98 | $138.02 | $198.33 |
- 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
- $103.24 / $206.48 / $720.00
| Professional | | $103.24 | $206.48 | $720.00 |
- 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
- $97.44 / $152.12 / $312.89
| Professional | | $97.44 | $152.12 | $312.89 |