- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.11 / $85.11 / $95.50
| Facility | | $85.11 | $85.11 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $100.00 / $269.15
| Professional | | $77.62 | $100.00 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $537.03 / $537.03
| Facility | | $537.03 | $537.03 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $117.49 / $288.40
| Professional | | $81.28 | $117.49 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $131.83 / $162.18
| Facility | | $100.00 | $131.83 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $117.49 / $229.09
| Professional | | $87.10 | $117.49 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $102.33 / $234.42
| Professional | | $69.18 | $102.33 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.13 / $89.13 / $114.82
| Facility | | $89.13 | $89.13 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $114.82 / $213.80
| Professional | | $63.10 | $114.82 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $147.91 / $263.03
| Professional | | $89.13 | $147.91 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.49 / $117.49 / $117.49
| Facility | | $117.49 | $117.49 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $691.83 / $691.83
| Professional | | $131.83 | $691.83 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $537.03 / $537.03
| Facility | | $537.03 | $537.03 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $117.49 / $288.40
| Professional | | $81.28 | $117.49 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $134.90 / $134.90
| Facility | | $134.90 | $134.90 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $112.20 / $269.15
| Professional | | $81.28 | $112.20 | $269.15 |