- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.38 / $3,263.31 / $9,540.46
| Facility | | $29.38 | $3,263.31 | $9,540.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.38 / $30.56 / $1,384.20
| Professional | | $29.38 | $30.56 | $1,384.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.51 / $75.00 / $146.90
| Facility | | $22.51 | $75.00 | $146.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.38 / $31.09 / $37.17
| Professional | | $29.38 | $31.09 | $37.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.50 / $35.02 / $39.60
| Facility | | $31.50 | $35.02 | $39.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.66 / $29.38 / $29.38
| Facility | | $27.66 | $29.38 | $29.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.38 / $29.38 / $29.38
| Professional | | $29.38 | $29.38 | $29.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.82 / $58.48 / $8,090.00
| Facility | | $29.82 | $58.48 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.11 / $29.38 / $61.02
| Professional | | $29.11 | $29.38 | $61.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,970.40 / $2,438.05 / $8,431.73
| Facility | | $1,970.40 | $2,438.05 | $8,431.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $75.00 / $146.90
| Facility | | $75.00 | $75.00 | $146.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.38 / $31.14 / $44.07
| Professional | | $29.38 | $31.14 | $44.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.78 / $28.49 / $51.10
| Facility | | $17.78 | $28.49 | $51.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.38 / $29.38 / $29.38
| Facility | | $29.38 | $29.38 | $29.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.38 / $31.14 / $43.49
| Professional | | $29.38 | $31.14 | $43.49 |