- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $302.00 / $602.56
| Facility | | $104.71 | $302.00 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $104.71 / $295.12
| Professional | | $81.28 | $104.71 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $141.25 / $354.81
| Facility | | $91.20 | $141.25 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $102.33 / $134.90
| Professional | | $91.20 | $102.33 | $134.90 |
- 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
- $112.20 / $112.20 / $125.89
| Professional | | $112.20 | $112.20 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.90 / $77.62 / $165.96
| Facility | | $38.90 | $77.62 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $128.82 / $131.83
| Professional | | $104.71 | $128.82 | $131.83 |
- 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
- $60.26 / $295.12 / $331.13
| Facility | | $60.26 | $295.12 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $141.25 / $354.81
| Facility | | $91.20 | $141.25 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $102.33 / $134.90
| Professional | | $91.20 | $102.33 | $134.90 |
- 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 |