- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $94.91 / $315.69 / $1,100.16
| Facility | | $94.91 | $315.69 | $1,100.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $10.50 / $66.43
| Professional | | $7.00 | $10.50 | $66.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.35 / $359.71 / $684.33
| Facility | | $138.35 | $359.71 | $684.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $68.01 / $68.01 / $72.73
| Facility | | $68.01 | $68.01 | $72.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.73 / $44.73 / $44.73
| Facility | | $44.73 | $44.73 | $44.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.46 / $139.16 / $349.34
| Facility | | $42.46 | $139.16 | $349.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.06 / $39.06 / $66.95
| Professional | | $39.06 | $39.06 | $66.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.00 / $100.00 / $100.00
| Facility | | $95.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,335.23 / $3,335.23 / $3,335.23
| Professional | | $3,335.23 | $3,335.23 | $3,335.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.17 / $198.90 / $812.20
| Facility | | $46.17 | $198.90 | $812.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.52 / $134.32 / $210.00
| Facility | | $45.52 | $134.32 | $210.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.06 / $39.06 / $66.95
| Professional | | $39.06 | $39.06 | $66.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.25 / $21.25 / $21.25
| Professional | | $21.25 | $21.25 | $21.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.00 / $40.07 / $40.07
| Professional | | $20.00 | $40.07 | $40.07 |