- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.10 / $128.82 / $331.13
| Facility | | $87.10 | $128.82 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $100.00 / $323.59
| Professional | | $83.18 | $100.00 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.33 / $281.84 / $338.84
| Facility | | $93.33 | $281.84 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.50 / $95.50 / $120.23
| Professional | | $0.50 | $95.50 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $114.82 / $223.87
| Facility | | $114.82 | $114.82 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $107.15 / $107.15
| Facility | | $107.15 | $107.15 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $107.15 / $107.15
| Professional | | $107.15 | $107.15 | $107.15 |
- 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
- $30.20 / $35.48 / $70.79
| Professional | | $30.20 | $35.48 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $100.00 / $181.97
| Professional | | $85.11 | $100.00 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.13 / $97.72 / $707.95
| Facility | | $89.13 | $97.72 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.33 / $281.84 / $338.84
| Facility | | $93.33 | $281.84 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.50 / $93.33 / $120.23
| Professional | | $0.50 | $93.33 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.77 / $48.98 / $52.48
| Facility | | $46.77 | $48.98 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $186.21 / $245.47
| Facility | | $114.82 | $186.21 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.10 / $109.65 / $144.54
| Professional | | $0.10 | $109.65 | $144.54 |