- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.27 / $45.27 / $115.85
| Facility | | $45.27 | $45.27 | $115.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.51 / $54.02 / $125.00
| Professional | | $44.51 | $54.02 | $125.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.80 / $194.63 / $489.49
| Facility | | $64.80 | $194.63 | $489.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $71.16 / $101.16
| Professional | | $40.74 | $71.16 | $101.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.96 / $133.77 / $172.28
| Facility | | $109.96 | $133.77 | $172.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.02 / $94.67 / $133.77
| Professional | | $67.02 | $94.67 | $133.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58.00 / $58.00 / $72.61
| Facility | | $58.00 | $58.00 | $72.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.34 / $56.94 / $92.50
| Professional | | $42.34 | $56.94 | $92.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.88 / $83.88 / $88.07
| Professional | | $83.88 | $83.88 | $88.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.10 / $44.10 / $50.84
| Facility | | $44.10 | $44.10 | $50.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.84 / $50.84 / $60.44
| Professional | | $50.84 | $50.84 | $60.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $182.56 / $489.49 / $489.49
| Facility | | $182.56 | $489.49 | $489.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.39 / $51.68 / $101.16
| Professional | | $37.39 | $51.68 | $101.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.51 / $95.33 / $171.82
| Professional | | $77.51 | $95.33 | $171.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.46 / $52.70 / $101.16
| Professional | | $40.46 | $52.70 | $101.16 |