- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $112.20 / $112.20
| Facility | | $112.20 | $112.20 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $120.23 / $239.88
| Professional | | $83.18 | $120.23 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $263.03 / $1,230.27
| Facility | | $199.53 | $263.03 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $181.97 / $263.03
| Professional | | $100.00 | $181.97 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $147.91 / $446.68
| Facility | | $147.91 | $147.91 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $194.98 / $194.98
| Professional | | $165.96 | $194.98 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $147.91 / $177.83
| Facility | | $134.90 | $147.91 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $144.54
| Professional | | $100.00 | $100.00 | $144.54 |
- 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
- $223.87 / $223.87 / $338.84
| Professional | | $223.87 | $223.87 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $138.04 / $138.04
| Professional | | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $263.03 / $1,230.27
| Facility | | $199.53 | $263.03 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $194.98 / $263.03
| Professional | | $100.00 | $194.98 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.16 / $114.82 / $275.42
| Facility | | $0.16 | $114.82 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $134.90 / $223.87
| Professional | | $97.72 | $134.90 | $223.87 |