- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.55 / $60.98 / $8,308.35
| Facility | | $47.55 | $60.98 | $8,308.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.55 / $48.02 / $4,560.00
| Professional | | $47.55 | $48.02 | $4,560.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.70 / $131.29 / $393.60
| Facility | | $32.70 | $131.29 | $393.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.55 / $49.93 / $160.44
| Professional | | $47.55 | $49.93 | $160.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.97 / $58.39 / $113.45
| Facility | | $50.97 | $58.39 | $113.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.59 / $78.22 / $98.75
| Professional | | $52.59 | $78.22 | $98.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.69 / $47.55 / $47.55
| Facility | | $34.69 | $47.55 | $47.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.55 / $47.55 / $47.55
| Professional | | $47.55 | $47.55 | $47.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.55 / $83.43 / $8,090.00
| Facility | | $47.55 | $83.43 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.13 / $47.22 / $47.55
| Professional | | $40.13 | $47.22 | $47.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.55 / $47.55 / $47.55
| Professional | | $47.55 | $47.55 | $47.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.64 / $393.60 / $393.60
| Facility | | $105.64 | $393.60 | $393.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.55 / $50.40 / $160.44
| Professional | | $47.55 | $50.40 | $160.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.33 / $32.85 / $51.93
| Facility | | $26.33 | $32.85 | $51.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.55 / $50.40 / $92.49
| Professional | | $47.55 | $50.40 | $92.49 |