- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $148.56 / $2,747.00 / $7,920.26
| Facility | | $148.56 | $2,747.00 | $7,920.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.29 / $93.95 / $223.81
| Professional | | $66.29 | $93.95 | $223.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $78.00 / $78.00 / $78.00
| Facility | | $78.00 | $78.00 | $78.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.67 / $152.69 / $239.58
| Professional | | $90.67 | $152.69 | $239.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.60 / $175.15 / $222.30
| Professional | | $141.60 | $175.15 | $222.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $90.23 / $147.05 / $205.84
| Facility | | $90.23 | $147.05 | $205.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.52 / $146.77 / $216.45
| Professional | | $112.52 | $146.77 | $216.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.17 / $162.81 / $182.91
| Facility | | $109.17 | $162.81 | $182.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $90.23 / $147.79 / $229.97
| Facility | | $90.23 | $147.79 | $229.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.16 / $167.58 / $233.38
| Professional | | $124.16 | $167.58 | $233.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $737.82 / $929.08 / $1,109.00
| Facility | | $737.82 | $929.08 | $1,109.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.24 / $174.24 / $243.83
| Professional | | $125.24 | $174.24 | $243.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $376.00 / $3,290.00 / $6,216.00
| Facility | | $376.00 | $3,290.00 | $6,216.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.49 / $174.99 / $269.58
| Professional | | $122.49 | $174.99 | $269.58 |