- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.86 / $46.16 / $9,219.25
| Facility | | $27.86 | $46.16 | $9,219.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.86 / $27.86 / $1,619.20
| Professional | | $27.86 | $27.86 | $1,619.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.31 / $81.29 / $304.70
| Facility | | $30.31 | $81.29 | $304.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.86 / $29.25 / $126.83
| Professional | | $27.86 | $29.25 | $126.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.87 / $34.21 / $66.47
| Facility | | $29.87 | $34.21 | $66.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.86 / $46.57 / $57.86
| Professional | | $27.86 | $46.57 | $57.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.86 / $27.86 / $28.73
| Facility | | $27.86 | $27.86 | $28.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.86 / $27.86 / $27.86
| Professional | | $27.86 | $27.86 | $27.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.43 / $57.70 / $8,090.00
| Facility | | $29.43 | $57.70 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.86 / $42.94 / $50.51
| Professional | | $27.86 | $42.94 | $50.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.86 / $27.86 / $27.86
| Professional | | $27.86 | $27.86 | $27.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $113.99 / $721.70 / $2,846.82
| Facility | | $113.99 | $721.70 | $2,846.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.29 / $304.70 / $304.70
| Facility | | $81.29 | $304.70 | $304.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.86 / $29.53 / $126.83
| Professional | | $27.86 | $29.53 | $126.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.77 / $32.18 / $46.83
| Facility | | $28.77 | $32.18 | $46.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.86 / $29.53 / $71.17
| Professional | | $27.86 | $29.53 | $71.17 |