- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.28 / $81.28 / $81.28
| Facility | | $81.28 | $81.28 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $87.10 / $234.42
| Professional | | $67.61 | $87.10 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $194.98 / $1,000.00
| Facility | | $169.82 | $194.98 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $144.54 / $194.98
| Professional | | $79.43 | $144.54 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $109.65 / $331.13
| Facility | | $109.65 | $109.65 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $165.96 / $165.96
| Professional | | $134.90 | $165.96 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $109.65 / $131.83
| Facility | | $100.00 | $109.65 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $72.44 / $107.15
| Professional | | $72.44 | $72.44 | $107.15 |
- 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
- $165.96 / $165.96 / $251.19
| Professional | | $165.96 | $165.96 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $102.33 / $102.33
| Professional | | $102.33 | $102.33 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $194.98 / $1,000.00
| Facility | | $169.82 | $194.98 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $144.54 / $213.80
| Professional | | $79.43 | $144.54 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.13 / $120.23 / $218.78
| Facility | | $0.13 | $120.23 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $120.23 / $165.96
| Professional | | $77.62 | $120.23 | $165.96 |