- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $86.54 / $2,747.00 / $4,834.72
| Facility | | $86.54 | $2,747.00 | $4,834.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.54 / $125.26 / $307.39
| Professional | | $86.54 | $125.26 | $307.39 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $221.07 / $221.07 / $221.07
| Professional | 50 | $221.07 | $221.07 | $221.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $185.61 / $1,251.81 / $3,804.00
| Facility | | $185.61 | $1,251.81 | $3,804.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.64 / $223.14 / $868.56
| Professional | | $91.64 | $223.14 | $868.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $98.18 / $127.63 / $225.22
| Facility | | $98.18 | $127.63 | $225.22 |
- 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
- $124.94 / $226.95 / $440.94
| Professional | | $124.94 | $226.95 | $440.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.35 / $179.02 / $6,679.00
| Facility | | $85.35 | $179.02 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.91 / $144.26 / $222.11
| Professional | | $74.91 | $144.26 | $222.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.64 / $228.66 / $327.38
| Professional | | $106.64 | $228.66 | $327.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.09 / $130.09 / $149.86
| Facility | | $130.09 | $130.09 | $149.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.19 / $65.51 / $284.08
| Professional | | $60.19 | $65.51 | $284.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,878.00 / $7,161.00
| Facility | | $55.00 | $1,878.00 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.55 / $357.88 / $868.56
| Professional | | $156.55 | $357.88 | $868.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.00 / $2,408.00 / $5,683.00
| Facility | | $1,106.00 | $2,408.00 | $5,683.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.08 / $194.63 / $443.71
| Professional | | $134.08 | $194.63 | $443.71 |