- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.89 / $363.08 / $676.08
| Facility | | $125.89 | $363.08 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $165.96 / $588.84
| Professional | | $125.89 | $165.96 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $239.88 / $1,000.00
| Facility | | $154.88 | $239.88 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $186.21 / $436.52
| Professional | | $87.10 | $186.21 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $416.87 / $602.56
| Facility | | $331.13 | $416.87 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $194.98 / $204.17
| Professional | | $169.82 | $194.98 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $263.03 / $501.19
| Facility | | $134.90 | $263.03 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $239.88 / $316.23
| Professional | | $95.50 | $239.88 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $3,630.78 / $9,772.37
| Facility | | $83.18 | $3,630.78 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $302.00 / $354.81
| Professional | | $302.00 | $302.00 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $208.93 / $457.09
| Professional | | $208.93 | $208.93 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $239.88 / $1,000.00
| Facility | | $154.88 | $239.88 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $186.21 / $436.52
| Professional | | $87.10 | $186.21 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.33 / $190.55 / $218.78
| Facility | | $93.33 | $190.55 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $125.89 / $407.38
| Professional | | $87.10 | $125.89 | $407.38 |