- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $229.09 / $229.09
| Facility | | $100.00 | $229.09 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.08 / $67.61 / $100.00
| Professional | | $7.08 | $67.61 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $45.71 / $245.47
| Professional | | $38.90 | $45.71 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $269.15 / $426.58
| Facility | | $229.09 | $269.15 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $125.89 / $263.03
| Professional | | $95.50 | $125.89 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.65 / $288.40 / $489.78
| Facility | | $43.65 | $288.40 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.65 / $79.43 / $398.11
| Facility | | $43.65 | $79.43 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $50.12 / $151.36
| Professional | | $41.69 | $50.12 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $54.95 / $229.09
| Professional | | $50.12 | $54.95 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $194.98 / $275.42
| Professional | | $107.15 | $194.98 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $165.96 / $398.11
| Facility | | $165.96 | $165.96 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $177.83 / $177.83
| Professional | | $177.83 | $177.83 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $457.09 / $630.96
| Professional | | $245.47 | $457.09 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.61 / $67.61 / $100.00
| Facility | | $67.61 | $67.61 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.48 / $50.12 / $162.18
| Professional | | $35.48 | $50.12 | $162.18 |