- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $197.72 / $1,411.87 / $3,103.52
| Facility | | $197.72 | $1,411.87 | $3,103.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.90 / $197.72 / $490.74
| Professional | | $132.90 | $197.72 | $490.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $198.42 / $941.10 / $12,000.00
| Facility | | $198.42 | $941.10 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.02 / $346.09 / $1,382.24
| Professional | | $156.02 | $346.09 | $1,382.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $164.16 / $210.95 / $376.25
| Facility | | $164.16 | $210.95 | $376.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.69 / $240.15 / $440.69
| Professional | | $129.69 | $240.15 | $440.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $219.46 / $276.31 / $500.00
| Facility | | $219.46 | $276.31 | $500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.39 / $295.23 / $570.41
| Professional | | $164.39 | $295.23 | $570.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.49 / $377.00 / $6,679.00
| Facility | | $140.49 | $377.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.25 / $287.25 / $417.83
| Professional | | $222.25 | $287.25 | $417.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.58 / $373.58 / $524.40
| Professional | | $200.58 | $373.58 | $524.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.27 / $429.38 / $675.99
| Facility | | $281.27 | $429.38 | $675.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.71 / $226.50 / $416.54
| Professional | | $172.71 | $226.50 | $416.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.00 / $1,078.00 / $12,000.00
| Facility | | $308.00 | $1,078.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.39 / $463.47 / $1,382.24
| Professional | | $221.39 | $463.47 | $1,382.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.00 / $1,078.00 / $2,733.00
| Facility | | $308.00 | $1,078.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.94 / $301.70 / $636.94
| Professional | | $196.94 | $301.70 | $636.94 |