- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $99.13 / $4,434.99 / $6,527.97
| Facility | | $99.13 | $4,434.99 | $6,527.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.13 / $103.09 / $124.45
| Professional | | $99.13 | $103.09 | $124.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.11 / $265.67 / $818.35
| Facility | | $141.11 | $265.67 | $818.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.13 / $105.08 / $266.16
| Professional | | $99.13 | $105.08 | $266.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.37 / $126.49 / $269.63
| Facility | | $106.37 | $126.49 | $269.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $99.13 / $99.13 / $125.30
| Facility | | $99.13 | $99.13 | $125.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.13 / $99.13 / $99.13
| Professional | | $99.13 | $99.13 | $99.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $99.13 / $163.86 / $8,090.00
| Facility | | $99.13 | $163.86 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.90 / $162.90 / $191.65
| Professional | | $162.90 | $162.90 | $191.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.13 / $99.13 / $433.15
| Professional | | $99.13 | $99.13 | $433.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,865.94 / $2,154.13 / $4,429.77
| Facility | | $1,865.94 | $2,154.13 | $4,429.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $417.50 / $417.50 / $1,345.20
| Facility | | $417.50 | $417.50 | $1,345.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.13 / $105.08 / $266.16
| Professional | | $99.13 | $105.08 | $266.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.61 / $164.11 / $346.71
| Facility | | $123.61 | $164.11 | $346.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.13 / $110.35 / $266.16
| Professional | | $99.13 | $110.35 | $266.16 |