- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $173.78 / $173.78
| Facility | | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $95.50 / $288.40
| Professional | | $46.77 | $95.50 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $389.05 / $389.05
| Facility | | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $100.00 / $1,000.00
| Professional | | $56.23 | $100.00 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $134.90 / $134.90
| Facility | | $134.90 | $134.90 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $67.61 / $67.61
| Professional | | $64.57 | $67.61 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $77.62 / $131.83
| Professional | | $31.62 | $77.62 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.26 / $60.26 / $60.26
| Facility | | $60.26 | $60.26 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $83.18 / $123.03
| Professional | | $66.07 | $83.18 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $123.03 / $177.83
| Professional | | $70.79 | $123.03 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $489.78 / $602.56
| Professional | | $295.12 | $489.78 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $389.05 / $389.05
| Facility | | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $100.00 / $1,000.00
| Professional | | $57.54 | $100.00 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $34.67 / $34.67
| Facility | | $34.67 | $34.67 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $81.28 / $169.82
| Professional | | $54.95 | $81.28 | $169.82 |