- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.02 / $281.84 / $794.33
| Facility | | $38.02 | $281.84 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $50.12 / $562.34
| Professional | | $30.20 | $50.12 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $223.87 / $416.87
| Professional | | $165.96 | $223.87 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $199.53 / $323.59
| Professional | | $100.00 | $199.53 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $208.93 / $302.00
| Professional | | $138.04 | $208.93 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $91.20 / $213.80
| Professional | | $52.48 | $91.20 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $181.97 / $338.84
| Professional | | $89.13 | $181.97 | $338.84 |
- 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
- $891.25 / $1,905.46 / $1,905.46
| Professional | | $891.25 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $54.95 / $54.95
| Professional | | $54.95 | $54.95 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.10 / $3,630.78 / $5,623.41
| Facility | | $87.10 | $3,630.78 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $208.93 / $323.59
| Professional | | $138.04 | $208.93 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $288.40 / $288.40
| Professional | | $288.40 | $288.40 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.20 / $25.12 / $93.33
| Professional | | $18.20 | $25.12 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.02 / $52.48 / $83.18
| Professional | | $38.02 | $52.48 | $83.18 |