- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $147.91 / $169.82
| Facility | | $109.65 | $147.91 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.89 / $100.00 / $302.00
| Professional | | $20.89 | $100.00 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.67 / $107.15 / $186.21
| Facility | | $44.67 | $107.15 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $35.48 / $48.98
| Professional | | $33.11 | $35.48 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58.88 / $72.44 / $104.71
| Facility | | $58.88 | $72.44 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $40.74 / $44.67
| Professional | | $40.74 | $40.74 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.90 / $83.18 / $165.96
| Facility | | $38.90 | $83.18 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $63.10 / $77.62
| Professional | | $63.10 | $63.10 | $77.62 |
- 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
- $14.79 / $14.79 / $85.11
| Professional | | $14.79 | $14.79 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $104.71 / $128.82
| Facility | | $104.71 | $104.71 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.67 / $107.15 / $186.21
| Facility | | $44.67 | $107.15 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $35.48 / $48.98
| Professional | | $33.11 | $35.48 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.15 / $61.66 / $169.82
| Facility | | $37.15 | $61.66 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $14.79 / $147.91
| Professional | | $12.02 | $14.79 | $147.91 |