- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $128.82 / $630.96
| Facility | | $128.82 | $128.82 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $154.88 / $446.68
| Professional | | $120.23 | $154.88 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $371.54 / $6,165.95
| Facility | | $100.00 | $371.54 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $295.12 / $3,981.07
| Professional | | $128.82 | $295.12 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,801.89 / $5,495.41
| Facility | | $3,019.95 | $3,801.89 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $5,754.40 / $13,489.63
| Facility | | $758.58 | $5,754.40 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $302.00 / $630.96
| Professional | | $128.82 | $302.00 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.13 / $158.49 / $8,511.38
| Facility | | $89.13 | $158.49 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $158.49 / $346.74
| Professional | | $91.20 | $158.49 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $263.03 / $512.86
| Professional | | $162.18 | $263.03 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $371.54 / $6,165.95
| Facility | | $100.00 | $371.54 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $295.12 / $3,981.07
| Professional | | $131.83 | $295.12 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $4,265.80 / $9,120.11
| Facility | | $114.82 | $4,265.80 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $288.40 / $676.08
| Professional | | $162.18 | $288.40 | $676.08 |