- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.40 / $68.40 / $9,242.26
| Facility | | $31.40 | $68.40 | $9,242.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.08 / $53.57 / $7,200.00
| Professional | | $31.08 | $53.57 | $7,200.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.50 / $31.93 / $71.83
| Facility | | $20.50 | $31.93 | $71.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.68 / $23.61 / $104.24
| Professional | | $19.68 | $23.61 | $104.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.30 / $92.60 / $113.55
| Facility | | $57.30 | $92.60 | $113.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.69 / $21.69 / $65.34
| Professional | | $21.69 | $21.69 | $65.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.64 / $17.64 / $19.98
| Facility | | $17.64 | $17.64 | $19.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.98 / $19.98 / $19.98
| Professional | | $19.98 | $19.98 | $19.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.98 / $23.99 / $50.97
| Professional | | $17.98 | $23.99 | $50.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $113.55 / $218.60 / $218.60
| Facility | | $113.55 | $218.60 | $218.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.64 / $19.98 / $32.97
| Facility | | $17.64 | $19.98 | $32.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.98 / $19.98 / $43.24
| Professional | | $19.98 | $19.98 | $43.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.25 / $99.25 / $99.25
| Professional | | $99.25 | $99.25 | $99.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.99 / $21.99 / $33.97
| Professional | | $15.99 | $21.99 | $33.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.09 / $40.09 / $103.15
| Professional | | $40.09 | $40.09 | $103.15 |