- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $72.44 / $72.44 / $72.44
| Facility | | $72.44 | $72.44 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $114.82 / $398.11
| Professional | | $72.44 | $114.82 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,884.03 / $9,549.93
| Facility | | $56.23 | $2,884.03 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $134.90 / $1,513.56
| Professional | | $93.33 | $134.90 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $269.15 / $295.12
| Professional | | $144.54 | $269.15 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $165.96 / $323.59
| Professional | | $100.00 | $165.96 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.28 / $169.82 / $8,511.38
| Facility | | $81.28 | $169.82 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $91.20 / $134.90
| Professional | | $47.86 | $91.20 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,265.80 / $9,772.37
| Facility | | $1,995.26 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $158.49 / $257.04
| Professional | | $95.50 | $158.49 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $158.49 / $158.49
| Professional | | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,801.89 / $9,549.93
| Facility | | $56.23 | $3,801.89 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $131.83 / $1,513.56
| Professional | | $93.33 | $131.83 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,265.80 / $9,772.37
| Facility | | $1,862.09 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $141.25 / $288.40
| Professional | | $100.00 | $141.25 | $288.40 |