- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.55 / $977.24 / $1,445.44
| Facility | | $9.55 | $977.24 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.91 / $8.91 / $60.26
| Professional | | $8.91 | $8.91 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $8,511.38 / $77,624.71
| Facility | | $5,011.87 | $8,511.38 | $77,624.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $66.07 / $66.07
| Professional | | $64.57 | $66.07 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $104.71 / $104.71
| Facility | | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $194.98 / $194.98
| Professional | | $194.98 | $194.98 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $138.04 / $138.04
| Facility | | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.55 / $977.24 / $1,445.44
| Facility | | $9.55 | $977.24 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.91 / $8.91 / $27.54
| Professional | | $8.91 | $8.91 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $173.78 / $173.78
| Facility | | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.60 / $0.60 / $173.78
| Professional | | $0.60 | $0.60 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.95 / $23.44 / $147.91
| Facility | | $19.95 | $23.44 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $23.44 / $309.03
| Professional | | $14.13 | $23.44 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $204.17 / $251.19
| Facility | | $100.00 | $204.17 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $31.62 / $79.43
| Professional | | $31.62 | $31.62 | $79.43 |