- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.61 / $67.61 / $1,288.25
| Facility | | $67.61 | $67.61 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $112.20 / $302.00
| Professional | | $75.86 | $112.20 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $218.78 / $2,630.27
| Facility | | $138.04 | $218.78 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $660.69 / $660.69
| Professional | | $288.40 | $660.69 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $173.78 / $275.42
| Facility | | $100.00 | $173.78 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.13 / $549.54 / $831.76
| Facility | | $74.13 | $549.54 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $165.96 / $363.08
| Professional | | $89.13 | $165.96 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $123.03 / $177.83
| Professional | | $28.84 | $123.03 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $173.78 / $223.87
| Professional | | $120.23 | $173.78 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $2,187.76
| Facility | | $2,187.76 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $218.78 / $2,630.27
| Facility | | $138.04 | $218.78 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $660.69 / $660.69
| Professional | | $288.40 | $660.69 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $158.49 / $288.40
| Facility | | $100.00 | $158.49 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $177.83 / $204.17
| Professional | | $138.04 | $177.83 | $204.17 |