- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $116.93 / $116.93 / $116.93
| Facility | | $116.93 | $116.93 | $116.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.93 / $153.37 / $390.00
| Professional | | $116.93 | $153.37 | $390.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.88 / $692.02 / $1,281.52
| Facility | | $208.88 | $692.02 | $1,281.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.11 / $203.10 / $261.35
| Professional | | $121.11 | $203.10 | $261.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.69 / $403.24 / $558.37
| Facility | | $346.69 | $403.24 | $558.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.14 / $252.15 / $329.75
| Professional | | $173.14 | $252.15 | $329.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $142.00 / $142.00 / $146.03
| Facility | | $142.00 | $142.00 | $146.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.66 / $142.00 / $318.00
| Professional | | $103.66 | $142.00 | $318.00 |
- 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
- $216.67 / $216.67 / $227.50
| Professional | | $216.67 | $216.67 | $227.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $121.11 / $121.11 / $161.44
| Facility | | $121.11 | $121.11 | $161.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.44 / $161.44 / $167.57
| Professional | | $161.44 | $161.44 | $167.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $556.61 / $1,281.52 / $1,281.52
| Facility | | $556.61 | $1,281.52 | $1,281.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.83 / $134.19 / $261.35
| Professional | | $101.83 | $134.19 | $261.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.88 / $208.88 / $208.88
| Professional | | $208.88 | $208.88 | $208.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.44 / $167.57 / $257.73
| Professional | | $105.44 | $167.57 | $257.73 |