- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.33 / $587.88 / $3,693.00
| Facility | | $74.33 | $587.88 | $3,693.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $148.66 / $148.66 / $148.66
| Facility | 50 | $148.66 | $148.66 | $148.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.35 / $120.77 / $238.86
| Professional | | $53.35 | $120.77 | $238.86 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $342.05 / $400.00 / $562.50
| Professional | 50 | $342.05 | $400.00 | $562.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.21 / $395.40 / $2,733.00
| Facility | | $114.21 | $395.40 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.22 / $145.94 / $675.70
| Professional | | $60.22 | $145.94 | $675.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.29 / $78.38 / $138.31
| Facility | | $60.29 | $78.38 | $138.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.19 / $90.22 / $155.97
| Professional | | $57.19 | $90.22 | $155.97 |
- 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
- $82.23 / $154.37 / $281.42
| Professional | | $82.23 | $154.37 | $281.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.98 / $168.26 / $6,679.00
| Facility | | $60.98 | $168.26 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.10 / $115.12 / $205.82
| Professional | | $91.10 | $115.12 | $205.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.50 / $141.08 / $215.92
| Professional | | $65.50 | $141.08 | $215.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $136.80 / $136.80 / $136.80
| Facility | | $136.80 | $136.80 | $136.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.72 / $151.30 / $151.30
| Professional | | $137.72 | $151.30 | $151.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,078.00 / $3,445.00
| Facility | | $55.00 | $1,078.00 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.91 / $221.60 / $675.70
| Professional | | $102.91 | $221.60 | $675.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $3,445.00
| Facility | | $627.00 | $1,818.00 | $3,445.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.48 / $155.49 / $288.56
| Professional | | $97.48 | $155.49 | $288.56 |