- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.27 / $67.27 / $701.22
| Facility | | $67.27 | $67.27 | $701.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.98 / $71.39 / $81.84
| Professional | | $56.98 | $71.39 | $81.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,083.51 / $1,395.00 / $12,759.45
| Facility | | $1,083.51 | $1,395.00 | $12,759.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.17 / $71.95 / $71.95
| Professional | | $61.17 | $71.95 | $71.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.73 / $93.59 / $142.74
| Professional | | $71.73 | $93.59 | $142.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.08 / $113.65 / $113.65
| Professional | | $85.08 | $113.65 | $113.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $304.00 / $370.55 / $435.94
| Facility | | $304.00 | $370.55 | $435.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.27 / $383.04 / $2,025.00
| Facility | | $67.27 | $383.04 | $2,025.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.71 / $74.73 / $131.85
| Professional | | $59.71 | $74.73 | $131.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.20 / $107.60 / $182.90
| Professional | | $78.20 | $107.60 | $182.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.69 / $93.59 / $147.11
| Professional | | $68.69 | $93.59 | $147.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.00 / $68.04 / $68.04
| Facility | | $64.00 | $68.04 | $68.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.00 / $68.04 / $73.04
| Professional | | $64.00 | $68.04 | $73.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.00 / $577.00 / $3,742.00
| Facility | | $162.00 | $577.00 | $3,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.34 / $80.36 / $136.76
| Professional | | $62.34 | $80.36 | $136.76 |