- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.00 / $41.00 / $1,719.00
| Facility | | $38.00 | $41.00 | $1,719.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $45.00 / $1,440.72
| Professional | | $30.00 | $45.00 | $1,440.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.47 / $515.70 / $858.24
| Professional | | $367.47 | $515.70 | $858.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $412.29 / $620.21
| Professional | | $100.00 | $412.29 | $620.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.00 / $560.00 / $837.84
| Professional | | $380.00 | $560.00 | $837.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.16 / $203.35 / $476.76
| Professional | | $115.16 | $203.35 | $476.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.64 / $432.00 / $758.70
| Professional | | $273.64 | $432.00 | $758.70 |
- 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
- $2,027.52 / $2,027.52 / $4,320.00
| Professional | | $2,027.52 | $2,027.52 | $4,320.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.44 / $560.00 / $640.00
| Professional | | $147.44 | $560.00 | $640.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $732.60 / $3,375.00 / $4,100.00
| Facility | | $732.60 | $3,375.00 | $4,100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.00 / $568.00 / $760.00
| Professional | | $400.00 | $568.00 | $760.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.00 / $776.00 / $776.00
| Professional | | $776.00 | $776.00 | $776.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.05 / $24.84 / $246.66
| Professional | | $18.05 | $24.84 | $246.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.00 / $52.00 / $84.67
| Professional | | $38.00 | $52.00 | $84.67 |