- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.62 / $346.74 / $794.33
| Facility | | $77.62 | $346.74 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $100.00 / $346.74
| Professional | | $58.88 | $100.00 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $575.44 / $2,818.38
| Facility | | $56.23 | $575.44 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $104.71 / $263.03
| Professional | | $61.66 | $104.71 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.79 / $70.79 / $158.49
| Facility | | $70.79 | $70.79 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $120.23 / $186.21
| Professional | | $70.79 | $120.23 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $50.12 / $50.12
| Facility | | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $123.03 / $218.78
| Professional | | $66.07 | $123.03 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.54 / $123.03 / $7,079.46
| Facility | | $57.54 | $123.03 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $123.03 / $154.88
| Professional | | $100.00 | $123.03 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,041.74 / $3,467.37
| Facility | | $630.96 | $2,041.74 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $117.49 / $229.09
| Professional | | $67.61 | $117.49 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.89 / $245.47 / $436.52
| Facility | | $125.89 | $245.47 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $138.04 / $177.83
| Professional | | $47.86 | $138.04 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $575.44 / $2,818.38
| Facility | | $56.23 | $575.44 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $104.71 / $263.03
| Professional | | $61.66 | $104.71 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,819.70 / $2,818.38
| Facility | | $501.19 | $1,819.70 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $112.20 / $229.09
| Professional | | $67.61 | $112.20 | $229.09 |