- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.74 / $100.00 / $186.21
| Facility | | $40.74 | $100.00 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $40.74 / $109.65
| Professional | | $32.36 | $40.74 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $61.66 / $154.88
| Facility | | $39.81 | $61.66 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.30 / $44.67 / $144.54
| Professional | | $26.30 | $44.67 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.11 / $107.15 / $154.88
| Facility | | $85.11 | $107.15 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.66 / $56.23 / $56.23
| Professional | | $42.66 | $56.23 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.88 / $60.26 / $91.20
| Facility | | $33.88 | $60.26 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.30 / $43.65 / $114.82
| Professional | | $26.30 | $43.65 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $63.10 / $74.13
| Professional | | $63.10 | $63.10 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $43.65 / $93.33
| Professional | | $43.65 | $43.65 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $61.66 / $154.88
| Facility | | $39.81 | $61.66 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.30 / $44.67 / $162.18
| Professional | | $26.30 | $44.67 | $162.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.48 / $43.65 / $70.79
| Facility | | $35.48 | $43.65 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.30 / $43.65 / $91.20
| Professional | | $26.30 | $43.65 | $91.20 |