- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $163.00 / $163.00 / $163.00
| Facility | | $163.00 | $163.00 | $163.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.00 / $179.67 / $276.44
| Professional | | $163.00 | $179.67 | $276.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.18 / $941.10 / $2,362.69
| Facility | | $160.18 | $941.10 | $2,362.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.18 / $284.07 / $364.32
| Professional | | $160.18 | $284.07 | $364.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $215.78 / $215.78 / $640.87
| Facility | | $215.78 | $215.78 | $640.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.28 / $310.62 / $310.62
| Professional | | $244.28 | $310.62 | $310.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $215.78 / $274.20 / $291.02
| Facility | | $215.78 | $274.20 | $291.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.45 / $291.02 / $544.88
| Professional | | $212.45 | $291.02 | $544.88 |
- 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
- $302.05 / $302.05 / $317.14
| Professional | | $302.05 | $302.05 | $317.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.60 / $235.60 / $235.60
| Professional | | $235.60 | $235.60 | $235.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,116.90 / $2,362.69 / $2,362.69
| Facility | | $1,116.90 | $2,362.69 | $2,362.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.40 / $199.42 / $364.32
| Professional | | $143.40 | $199.42 | $364.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.30 / $184.46 / $211.05
| Facility | | $0.30 | $184.46 | $211.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.19 / $199.42 / $364.32
| Professional | | $154.19 | $199.42 | $364.32 |