- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $549.54 / $912.01
| Facility | | $100.00 | $549.54 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $223.87 / $707.95
| Professional | | $100.00 | $223.87 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $891.25 / $6,606.93
| Facility | | $309.03 | $891.25 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $281.84 / $933.25
| Professional | | $169.82 | $281.84 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $562.34 / $812.83
| Facility | | $446.68 | $562.34 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $46.77 / $275.42
| Professional | | $46.77 | $46.77 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $354.81 / $549.54
| Facility | | $181.97 | $354.81 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $302.00 / $741.31
| Professional | | $169.82 | $302.00 | $741.31 |
- 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
- $407.38 / $407.38 / $478.63
| Professional | | $407.38 | $407.38 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $281.84 / $602.56
| Professional | | $281.84 | $281.84 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $891.25 / $6,606.93
| Facility | | $309.03 | $891.25 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $281.84 / $933.25
| Professional | | $169.82 | $281.84 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $281.84 / $338.84
| Facility | | $169.82 | $281.84 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $281.84 / $549.54
| Professional | | $169.82 | $281.84 | $549.54 |