- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.33 / $851.14 / $2,041.74
| Facility | | $93.33 | $851.14 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $112.20 / $302.00
| Professional | | $81.28 | $112.20 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $223.87 / $354.81
| Facility | | $100.00 | $223.87 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $61.66 / $61.66
| Professional | | $61.66 | $61.66 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.43 / $79.43 / $79.43
| Facility | | $79.43 | $79.43 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.11 / $169.82 / $1,000.00
| Facility | | $85.11 | $169.82 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $128.82 / $323.59
| Professional | | $83.18 | $128.82 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,630.27 / $2,630.27
| Facility | | $2,137.96 | $2,630.27 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $912.01 / $912.01
| Professional | | $660.69 | $912.01 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.11 / $134.90 / $478.63
| Facility | | $85.11 | $134.90 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $125.89 / $389.05
| Professional | | $83.18 | $125.89 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $44.67
| Professional | | $30.20 | $30.20 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.33 / $138.04 / $302.00
| Facility | | $93.33 | $138.04 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $123.03 / $302.00
| Professional | | $83.18 | $123.03 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.79 / $138.04 / $181.97
| Facility | | $70.79 | $138.04 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $109.65 / $112.20
| Professional | | $109.65 | $109.65 | $112.20 |