- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $102.33 / $165.96
| Facility | | $102.33 | $102.33 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $112.20 / $239.88
| Professional | | $79.43 | $112.20 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $245.47 / $977.24
| Facility | | $186.21 | $245.47 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $169.82 / $245.47
| Professional | | $93.33 | $169.82 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $354.81 / $467.74
| Facility | | $295.12 | $354.81 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $173.78 / $173.78
| Professional | | $154.88 | $173.78 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $138.04 / $173.78
| Facility | | $138.04 | $138.04 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $204.17
| Professional | | $100.00 | $100.00 | $204.17 |
- 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
- $208.93 / $208.93 / $316.23
| Professional | | $208.93 | $208.93 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $123.03 / $123.03
| Professional | | $123.03 | $123.03 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $245.47 / $977.24
| Facility | | $186.21 | $245.47 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $181.97 / $245.47
| Professional | | $93.33 | $181.97 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.15 / $107.15 / $263.03
| Facility | | $0.15 | $107.15 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $125.89 / $208.93
| Professional | | $91.20 | $125.89 | $208.93 |