- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.00 / $51.00 / $51.00
| Facility | | $51.00 | $51.00 | $51.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.00 / $51.00 / $53.04
| Professional | | $51.00 | $51.00 | $53.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.55 / $156.16 / $231.33
| Facility | | $53.55 | $156.16 | $231.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.00 / $51.00 / $231.33
| Professional | | $51.00 | $51.00 | $231.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.72 / $62.63 / $115.01
| Facility | | $54.72 | $62.63 | $115.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.00 / $51.00 / $51.00
| Facility | | $51.00 | $51.00 | $51.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.00 / $51.00 / $51.00
| Professional | | $51.00 | $51.00 | $51.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.02 / $80.58 / $8,090.00
| Facility | | $52.02 | $80.58 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.88 / $71.88 / $84.56
| Professional | | $71.88 | $71.88 | $84.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.00 / $51.00 / $51.00
| Professional | | $51.00 | $51.00 | $51.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,758.68 / $2,758.68 / $2,758.68
| Facility | | $2,758.68 | $2,758.68 | $2,758.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $75.00 / $231.33
| Facility | | $75.00 | $75.00 | $231.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.00 / $51.00 / $231.33
| Professional | | $51.00 | $51.00 | $231.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.00 / $51.00 / $101.36
| Professional | | $51.00 | $51.00 | $101.36 |