- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $205.18 / $1,796.48 / $3,363.00
| Facility | | $205.18 | $1,796.48 | $3,363.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.51 / $137.11 / $231.89
| Professional | | $65.51 | $137.11 | $231.89 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $342.67 / $342.67 / $342.67
| Professional | 50 | $342.67 | $342.67 | $342.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.59 / $1,177.70 / $7,161.00
| Facility | | $169.59 | $1,177.70 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.67 / $215.49 / $1,126.56
| Professional | | $85.67 | $215.49 | $1,126.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $82.37 / $105.85 / $210.04
| Facility | | $82.37 | $105.85 | $210.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.48 / $210.47 / $364.22
| Professional | | $115.48 | $210.47 | $364.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.88 / $178.89 / $356.40
| Professional | | $85.88 | $178.89 | $356.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $82.99 / $261.42 / $6,679.00
| Facility | | $82.99 | $261.42 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.47 / $220.15 / $303.89
| Professional | | $180.47 | $220.15 | $303.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.84 / $201.27 / $460.63
| Professional | | $95.84 | $201.27 | $460.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $435.99 / $922.50 / $1,234.84
| Facility | | $435.99 | $922.50 | $1,234.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.19 / $164.48 / $284.54
| Professional | | $114.19 | $164.48 | $284.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $351.41 / $2,078.00 / $15,000.00
| Facility | | $351.41 | $2,078.00 | $15,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.61 / $304.36 / $1,126.56
| Professional | | $154.61 | $304.36 | $1,126.56 |
- 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
- $146.22 / $227.59 / $443.15
| Professional | | $146.22 | $227.59 | $443.15 |