- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.66 / $61.66 / $1,412.54
| Facility | | $61.66 | $61.66 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $72.44 / $131.83
| Professional | | $57.54 | $72.44 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $186.21 / $676.08
| Facility | | $134.90 | $186.21 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $109.65 / $165.96
| Professional | | $58.88 | $109.65 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $158.49 / $478.63
| Facility | | $158.49 | $158.49 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $120.23 / $120.23
| Professional | | $93.33 | $120.23 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.28 / $100.00 / $158.49
| Facility | | $81.28 | $100.00 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $60.26 / $89.13
| Professional | | $60.26 | $60.26 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $125.89 / $190.55
| Professional | | $125.89 | $125.89 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $85.11 / $85.11
| Professional | | $85.11 | $85.11 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $186.21 / $676.08
| Facility | | $134.90 | $186.21 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $109.65 / $177.83
| Professional | | $58.88 | $109.65 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.10 / $83.18 / $177.83
| Facility | | $0.10 | $83.18 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $83.18 / $125.89
| Professional | | $56.23 | $83.18 | $125.89 |