- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $125.89 / $154.88
| Facility | | $100.00 | $125.89 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $114.82 / $338.84
| Professional | | $70.79 | $114.82 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $371.54 / $707.95
| Facility | | $91.20 | $371.54 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $154.88 / $691.83
| Professional | | $87.10 | $154.88 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $239.88 / $316.23
| Facility | | $107.15 | $239.88 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $204.17 / $302.00
| Professional | | $134.90 | $204.17 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $186.21 / $275.42
| Professional | | $100.00 | $186.21 | $275.42 |
- 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
- $63.10 / $109.65 / $186.21
| Professional | | $63.10 | $109.65 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $194.98 / $275.42
| Professional | | $109.65 | $194.98 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $199.53 / $309.03
| Professional | | $138.04 | $199.53 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $371.54 / $707.95
| Facility | | $91.20 | $371.54 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $154.88 / $691.83
| Professional | | $87.10 | $154.88 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $100.00 / $190.55
| Professional | | $72.44 | $100.00 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.62 / $77.62 / $77.62
| Facility | | $77.62 | $77.62 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $154.88 / $288.40
| Professional | | $91.20 | $154.88 | $288.40 |