- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.56 / $856.00 / $2,029.00
| Facility | | $93.56 | $856.00 | $2,029.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.52 / $100.46 / $171.00
| Professional | | $79.52 | $100.46 | $171.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.78 / $212.29 / $374.31
| Facility | | $91.78 | $212.29 | $374.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.35 / $62.35 / $62.35
| Professional | | $62.35 | $62.35 | $62.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $600.00 / $600.00 / $850.00
| Facility | | $600.00 | $600.00 | $850.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $80.00 / $80.00
| Facility | | $80.00 | $80.00 | $80.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.04 / $195.19 / $1,000.00
| Facility | | $107.04 | $195.19 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.00 / $116.37 / $290.00
| Professional | | $79.00 | $116.37 | $290.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $220.25 / $2,613.82 / $2,613.82
| Facility | | $220.25 | $2,613.82 | $2,613.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $661.49 / $661.49 / $915.00
| Professional | | $661.49 | $661.49 | $915.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.39 / $122.46 / $275.00
| Facility | | $81.39 | $122.46 | $275.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.70 / $80.70 / $80.70
| Professional | | $80.70 | $80.70 | $80.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.39 / $123.28 / $284.86
| Facility | | $81.39 | $123.28 | $284.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.70 / $116.37 / $288.44
| Professional | | $80.70 | $116.37 | $288.44 |