- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.34 / $4,701.95 / $24,556.26
| Facility | | $89.34 | $4,701.95 | $24,556.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.34 / $92.92 / $122.69
| Professional | | $89.34 | $92.92 | $122.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.41 / $239.43 / $641.79
| Facility | | $131.41 | $239.43 | $641.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.34 / $94.70 / $545.53
| Professional | | $89.34 | $94.70 | $545.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.86 / $114.00 / $243.00
| Facility | | $95.86 | $114.00 | $243.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.98 / $89.34 / $89.34
| Facility | | $19.98 | $89.34 | $89.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.34 / $89.34 / $89.34
| Professional | | $89.34 | $89.34 | $89.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.57 / $92.27 / $8,090.00
| Facility | | $59.57 | $92.27 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.34 / $89.34 / $185.54
| Professional | | $89.34 | $89.34 | $185.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $314.80 / $6,742.75 / $22,633.55
| Facility | | $314.80 | $6,742.75 | $22,633.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $641.79 / $641.79 / $641.79
| Facility | | $641.79 | $641.79 | $641.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.34 / $94.70 / $545.53
| Professional | | $89.34 | $94.70 | $545.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.38 / $109.46 / $298.30
| Facility | | $21.38 | $109.46 | $298.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.34 / $94.70 / $545.53
| Professional | | $89.34 | $94.70 | $545.53 |