- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.60 / $2,747.00 / $4,806.64
| Facility | | $110.60 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.55 / $125.54 / $196.24
| Professional | | $101.55 | $125.54 | $196.24 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $165.51 / $287.39 / $861.51
| Professional | 50 | $165.51 | $287.39 | $861.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $179.85 / $612.10 / $2,713.00
| Facility | | $179.85 | $612.10 | $2,713.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.45 / $145.75 / $577.52
| Professional | | $74.45 | $145.75 | $577.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.71 / $124.23 / $219.56
| Facility | | $95.71 | $124.23 | $219.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.88 / $171.79 / $240.21
| Professional | | $120.88 | $171.79 | $240.21 |
- 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
- $90.42 / $168.37 / $295.60
| Professional | | $90.42 | $168.37 | $295.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $174.52 / $6,679.00
| Facility | | $83.43 | $174.52 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.04 / $134.34 / $185.61
| Professional | | $106.04 | $134.34 | $185.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.08 / $200.05 / $289.73
| Professional | | $97.08 | $200.05 | $289.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,863.50 / $3,863.50 / $3,863.50
| Facility | | $3,863.50 | $3,863.50 | $3,863.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.56 / $157.19 / $170.52
| Professional | | $73.56 | $157.19 | $170.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $966.90 / $3,445.00
| Facility | | $55.00 | $966.90 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.52 / $166.95 / $1,055.57
| Professional | | $98.52 | $166.95 | $1,055.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $1,790.00 / $2,733.00
| Facility | | $500.00 | $1,790.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.77 / $143.55 / $278.56
| Professional | | $91.77 | $143.55 | $278.56 |