- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.47 / $153.97 / $3,496.83
| Facility | | $108.47 | $153.97 | $3,496.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.47 / $108.47 / $136.66
| Professional | | $108.47 | $108.47 | $136.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $111.99 / $332.14 / $1,578.65
| Facility | | $111.99 | $332.14 | $1,578.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.47 / $113.89 / $1,698.40
| Professional | | $108.47 | $113.89 | $1,698.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $116.28 / $133.19 / $258.81
| Facility | | $116.28 | $133.19 | $258.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.97 / $177.87 / $236.00
| Professional | | $119.97 | $177.87 | $236.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.47 / $108.47 / $136.05
| Facility | | $108.47 | $108.47 | $136.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.47 / $108.47 / $138.77
| Professional | | $108.47 | $108.47 | $138.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.47 / $172.66 / $8,090.00
| Facility | | $108.47 | $172.66 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.47 / $108.47 / $108.47
| Professional | | $108.47 | $108.47 | $108.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.47 / $108.47 / $108.47
| Professional | | $108.47 | $108.47 | $108.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $359.73 / $426.49 / $2,705.04
| Facility | | $359.73 | $426.49 | $2,705.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $581.41 / $1,578.65 / $1,578.65
| Facility | | $581.41 | $1,578.65 | $1,578.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.47 / $114.98 / $1,698.40
| Professional | | $108.47 | $114.98 | $1,698.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.24 / $130.24 / $130.24
| Facility | | $130.24 | $130.24 | $130.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.47 / $114.98 / $255.99
| Professional | | $108.47 | $114.98 | $255.99 |