- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.10 / $63.10 / $63.10
| Facility | | $63.10 | $63.10 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $70.79 / $144.54
| Professional | | $61.66 | $70.79 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $147.91 / $776.25
| Facility | | $128.82 | $147.91 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $109.65 / $147.91
| Professional | | $63.10 | $109.65 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $83.18 / $251.19
| Facility | | $83.18 | $83.18 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $120.23 / $120.23
| Professional | | $104.71 | $120.23 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $100.00 / $100.00
| Facility | | $83.18 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $72.44 / $100.00
| Professional | | $72.44 | $72.44 | $100.00 |
- 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
- $125.89 / $125.89 / $190.55
| Professional | | $125.89 | $125.89 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Professional | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $147.91 / $776.25
| Facility | | $128.82 | $147.91 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $112.20 / $162.18
| Professional | | $63.10 | $112.20 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.10 / $93.33 / $169.82
| Facility | | $0.10 | $93.33 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $93.33 / $125.89
| Professional | | $60.26 | $93.33 | $125.89 |