- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.50 / $3,734.10 / $9,289.73
| Facility | | $37.50 | $3,734.10 | $9,289.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.53 / $1,620.72 / $4,669.50
| Professional | | $29.53 | $1,620.72 | $4,669.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.09 / $31.87 / $8,639.91
| Facility | | $27.09 | $31.87 | $8,639.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.49 / $30.49 / $31.88
| Professional | | $30.49 | $30.49 | $31.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.72 / $29.38 / $29.38
| Facility | | $27.72 | $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
- $28.49 / $63.71 / $100.88
| Facility | | $28.49 | $63.71 | $100.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.63 / $4,032.00 / $9,391.96
| Facility | | $33.63 | $4,032.00 | $9,391.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.53 / $1,395.00 / $3,839.63
| Professional | | $29.53 | $1,395.00 | $3,839.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.72 / $29.38 / $29.38
| Facility | | $27.72 | $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
- $23.07 / $23.07 / $26.77
| Facility | | $23.07 | $23.07 | $26.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.07 / $23.07 / $26.77
| Professional | | $23.07 | $23.07 | $26.77 |
- 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 / $42.60
| Professional | | $29.38 | $31.14 | $42.60 |