- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.22 / $106.56 / $28,416.33
| Facility | | $75.22 | $106.56 | $28,416.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.22 / $75.22 / $91.12
| Professional | | $75.22 | $75.22 | $91.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $82.25 / $201.59 / $462.80
| Facility | | $82.25 | $201.59 | $462.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.22 / $78.98 / $359.03
| Professional | | $75.22 | $78.98 | $359.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.64 / $92.37 / $169.62
| Facility | | $80.64 | $92.37 | $169.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.98 / $127.10 / $163.66
| Professional | | $95.98 | $127.10 | $163.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.22 / $75.22 / $86.87
| Facility | | $75.22 | $75.22 | $86.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.22 / $75.22 / $75.22
| Professional | | $75.22 | $75.22 | $75.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.93 / $119.97 / $8,090.00
| Facility | | $75.93 | $119.97 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.22 / $75.22 / $75.22
| Professional | | $75.22 | $75.22 | $75.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.22 / $75.22 / $87.06
| Professional | | $75.22 | $75.22 | $87.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,443.65 / $11,456.23 / $26,430.43
| Facility | | $5,443.65 | $11,456.23 | $26,430.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.74 / $462.80 / $462.80
| Facility | | $112.74 | $462.80 | $462.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.22 / $79.73 / $359.03
| Professional | | $75.22 | $79.73 | $359.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.22 / $79.73 / $103.72
| Professional | | $75.22 | $79.73 | $103.72 |