- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.97 / $2,618.00 / $2,900.00
| Facility | | $16.97 | $2,618.00 | $2,900.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.97 / $41.36 / $76.31
| Professional | | $16.97 | $41.36 | $76.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.13 / $135.35 / $180.58
| Facility | | $21.13 | $135.35 | $180.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.32 / $116.46 / $537.69
| Professional | | $31.32 | $116.46 | $537.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.22 / $24.22 / $30.74
| Facility | | $24.22 | $24.22 | $30.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.22 / $24.22 / $102.78
| Professional | | $24.22 | $24.22 | $102.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.04 / $29.04 / $29.04
| Facility | | $29.04 | $29.04 | $29.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.09 / $74.09 / $92.77
| Professional | | $74.09 | $74.09 | $92.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.50 / $21.50 / $27.40
| Facility | | $21.50 | $21.50 | $27.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.58 / $119.48 / $164.93
| Professional | | $95.58 | $119.48 | $164.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $71.89 / $227.34
| Professional | | $36.31 | $71.89 | $227.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $135.35 / $135.35 / $135.35
| Facility | | $135.35 | $135.35 | $135.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.78 / $156.33 / $537.69
| Professional | | $52.78 | $156.33 | $537.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.17 / $112.60 / $240.77
| Professional | | $48.17 | $112.60 | $240.77 |