- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.72 / $30.72 / $117.78
| Facility | | $30.72 | $30.72 | $117.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.72 / $44.12 / $150.00
| Professional | | $30.72 | $44.12 | $150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.38 / $237.27 / $453.98
| Facility | | $128.38 | $237.27 | $453.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.68 / $60.68 / $100.89
| Professional | | $44.68 | $60.68 | $100.89 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $66.98 / $90.00 / $146.79
| Professional | 50 | $66.98 | $90.00 | $146.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.70 / $100.33 / $241.36
| Facility | | $70.70 | $100.33 | $241.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.63 / $78.53 / $124.32
| Professional | | $48.63 | $78.53 | $124.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.51 / $91.73 / $190.05
| Facility | | $57.51 | $91.73 | $190.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.58 / $68.64 / $115.37
| Professional | | $47.58 | $68.64 | $115.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.89 / $58.22 / $370.90
| Facility | | $32.89 | $58.22 | $370.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.99 / $82.07 / $217.84
| Professional | | $43.99 | $82.07 | $217.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $98.46 / $98.46 / $98.46
| Professional | 50 | $98.46 | $98.46 | $98.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $563.00 / $1,749.00 / $2,883.00
| Facility | | $563.00 | $1,749.00 | $2,883.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.02 / $81.76 / $152.85
| Professional | | $41.02 | $81.76 | $152.85 |