- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.74 / $51.65 / $13,194.00
| Facility | | $36.74 | $51.65 | $13,194.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.74 / $36.74 / $42.16
| Professional | | $36.74 | $36.74 | $42.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.54 / $98.46 / $183.70
| Facility | | $32.54 | $98.46 | $183.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.74 / $36.74 / $161.83
| Professional | | $36.74 | $36.74 | $161.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.39 / $45.12 / $87.66
| Facility | | $39.39 | $45.12 | $87.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.65 / $36.74 / $36.74
| Facility | | $36.65 | $36.74 | $36.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.74 / $36.74 / $36.74
| Professional | | $36.74 | $36.74 | $36.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.39 / $73.31 / $8,090.00
| Facility | | $37.39 | $73.31 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.74 / $36.74 / $36.74
| Professional | | $36.74 | $36.74 | $36.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.74 / $36.74 / $42.52
| Professional | | $36.74 | $36.74 | $42.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,814.86 / $3,814.86 / $7,531.37
| Facility | | $3,814.86 | $3,814.86 | $7,531.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $183.70 / $183.70
| Facility | | $75.00 | $183.70 | $183.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.74 / $38.94 / $161.83
| Professional | | $36.74 | $38.94 | $161.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.74 / $39.75 / $51.69
| Facility | | $36.74 | $39.75 | $51.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.74 / $36.74 / $47.59
| Professional | | $36.74 | $36.74 | $47.59 |