- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.00 / $41.00 / $1,337.00
| Facility | | $38.00 | $41.00 | $1,337.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $45.00 / $1,120.56
| Professional | | $30.00 | $45.00 | $1,120.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.69 / $401.10 / $667.52
| Professional | | $291.69 | $401.10 | $667.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $320.67 / $482.38
| Professional | | $100.00 | $320.67 | $482.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.00 / $420.00 / $628.38
| Professional | | $285.00 | $420.00 | $628.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.94 / $158.82 / $372.36
| Professional | | $89.94 | $158.82 | $372.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.67 / $350.00 / $590.10
| Professional | | $215.67 | $350.00 | $590.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $82.00 / $82.00 / $82.00
| Facility | | $82.00 | $82.00 | $82.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,576.96 / $1,576.96 / $3,360.00
| Professional | | $1,576.96 | $1,576.96 | $3,360.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.58 / $420.00 / $480.00
| Professional | | $110.58 | $420.00 | $480.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $569.79 / $3,375.00 / $4,100.00
| Facility | | $569.79 | $3,375.00 | $4,100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.00 / $432.00 / $582.75
| Professional | | $300.00 | $432.00 | $582.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $582.00 / $582.00 / $582.00
| Professional | | $582.00 | $582.00 | $582.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.05 / $24.84 / $185.16
| Professional | | $18.05 | $24.84 | $185.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.00 / $52.00 / $84.70
| Professional | | $38.00 | $52.00 | $84.70 |