- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $212.00 / $212.00 / $212.00
| Facility | | $212.00 | $212.00 | $212.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.00 / $212.00 / $319.68
| Professional | | $212.00 | $212.00 | $319.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $274.89 / $936.47 / $2,544.05
| Facility | | $274.89 | $936.47 | $2,544.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.54 / $317.83 / $473.85
| Professional | | $189.54 | $317.83 | $473.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $280.66 / $280.66 / $833.56
| Facility | | $280.66 | $280.66 | $833.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.73 / $374.07 / $374.07
| Professional | | $317.73 | $374.07 | $374.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.00 / $280.66 / $340.15
| Facility | | $251.00 | $280.66 | $340.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.23 / $251.00 / $465.75
| Professional | | $183.23 | $251.00 | $465.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.86 / $392.86 / $412.50
| Professional | | $392.86 | $392.86 | $412.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.22 / $255.22 / $255.22
| Professional | | $255.22 | $255.22 | $255.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $936.47 / $2,544.05 / $2,544.05
| Facility | | $936.47 | $2,544.05 | $2,544.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.00 / $242.07 / $473.85
| Professional | | $167.00 | $242.07 | $473.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $345.78 / $345.78 / $345.78
| Facility | | $345.78 | $345.78 | $345.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.85 / $242.07 / $473.85
| Professional | | $169.85 | $242.07 | $473.85 |