- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $114.82 / $269.15
| Professional | | $97.72 | $114.82 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $239.88 / $1,380.38
| Facility | | $181.97 | $239.88 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $177.83 / $239.88
| Professional | | $97.72 | $177.83 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $134.90 / $407.38
| Facility | | $134.90 | $134.90 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $177.83 / $177.83
| Professional | | $151.36 | $177.83 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $134.90 / $162.18
| Facility | | $134.90 | $134.90 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $138.04
| Professional | | $100.00 | $100.00 | $138.04 |
- 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
- $204.17 / $204.17 / $309.03
| Professional | | $204.17 | $204.17 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $120.23 / $120.23
| Professional | | $120.23 | $120.23 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $239.88 / $1,380.38
| Facility | | $181.97 | $239.88 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $177.83 / $239.88
| Professional | | $97.72 | $177.83 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.17 / $125.89 / $295.12
| Facility | | $0.17 | $125.89 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $138.04 / $204.17
| Professional | | $91.20 | $138.04 | $204.17 |