- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $179.49 / $1,294.00 / $2,900.00
| Facility | | $179.49 | $1,294.00 | $2,900.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.88 / $183.15 / $488.09
| Professional | | $91.88 | $183.15 | $488.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $296.00 / $1,267.00 / $12,000.00
| Facility | | $296.00 | $1,267.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.91 / $344.98 / $1,677.52
| Professional | | $144.91 | $344.98 | $1,677.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $122.25 / $157.09 / $289.58
| Facility | | $122.25 | $157.09 | $289.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.75 / $320.27 / $601.37
| Professional | | $155.75 | $320.27 | $601.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.00 / $500.00 / $1,089.54
| Facility | | $443.00 | $500.00 | $1,089.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.73 / $284.89 / $619.42
| Professional | | $126.73 | $284.89 | $619.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.62 / $377.00 / $6,679.00
| Facility | | $104.62 | $377.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.86 / $356.41 / $506.49
| Professional | | $272.86 | $356.41 | $506.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.01 / $291.80 / $640.19
| Professional | | $153.01 | $291.80 | $640.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $475.39 / $1,483.04 / $2,322.75
| Facility | | $475.39 | $1,483.04 | $2,322.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.48 / $164.95 / $376.23
| Professional | | $82.48 | $164.95 | $376.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,878.00 / $12,000.00
| Facility | | $540.00 | $1,878.00 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.28 / $560.76 / $1,677.52
| Professional | | $226.28 | $560.76 | $1,677.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $473.00 / $1,878.00 / $4,142.00
| Facility | | $473.00 | $1,878.00 | $4,142.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.27 / $338.82 / $781.89
| Professional | | $206.27 | $338.82 | $781.89 |