- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.36 / $104.48 / $17,808.98
| Facility | | $74.36 | $104.48 | $17,808.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.36 / $74.36 / $90.08
| Professional | | $74.36 | $74.36 | $90.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65.62 / $199.28 / $371.80
| Facility | | $65.62 | $199.28 | $371.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.36 / $76.54 / $1,209.31
| Professional | | $74.36 | $76.54 | $1,209.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.70 / $91.31 / $177.42
| Facility | | $79.70 | $91.31 | $177.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.24 / $124.30 / $154.41
| Professional | | $82.24 | $124.30 | $154.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $72.91 / $74.36 / $74.36
| Facility | | $72.91 | $74.36 | $74.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.36 / $74.36 / $74.37
| Professional | | $74.36 | $74.36 | $74.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.45 / $117.63 / $8,090.00
| Facility | | $74.45 | $117.63 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.91 / $45.91 / $74.36
| Professional | | $45.91 | $45.91 | $74.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.36 / $74.36 / $86.06
| Professional | | $74.36 | $74.36 | $86.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $582.69 / $784.46 / $7,072.00
| Facility | | $582.69 | $784.46 | $7,072.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $98.91 / $371.80 / $371.80
| Facility | | $98.91 | $371.80 | $371.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.36 / $78.81 / $1,209.31
| Professional | | $74.36 | $78.81 | $1,209.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.36 / $74.36 / $93.57
| Professional | | $74.36 | $74.36 | $93.57 |