- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.91 / $22.91 / $22.91
| Facility | | $22.91 | $22.91 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.91 / $33.11 / $100.00
| Professional | | $22.91 | $33.11 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.29 / $52.48 / $257.04
| Facility | | $51.29 | $52.48 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.55 / $41.69 / $79.43
| Professional | | $24.55 | $41.69 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.26 / $70.79 / $93.33
| Facility | | $60.26 | $70.79 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.48 / $37.15 / $37.15
| Professional | | $35.48 | $37.15 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.31 / $36.31 / $36.31
| Facility | | $36.31 | $36.31 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.30 / $26.30 / $42.66
| Professional | | $26.30 | $26.30 | $42.66 |
- 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
- $47.86 / $47.86 / $72.44
| Professional | | $47.86 | $47.86 | $72.44 |
- 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
- $35.48 / $35.48 / $43.65
| Professional | | $35.48 | $35.48 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.29 / $52.48 / $257.04
| Facility | | $51.29 | $52.48 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.55 / $44.67 / $83.18
| Professional | | $24.55 | $44.67 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $40.74 / $47.86
| Professional | | $38.90 | $40.74 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.50 / $32.36 / $38.90
| Facility | | $19.50 | $32.36 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.39 / $37.15 / $51.29
| Professional | | $22.39 | $37.15 | $51.29 |