- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $62.30 / $147.41 / $147.41
| Facility | | $62.30 | $147.41 | $147.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.71 / $125.62 / $237.28
| Professional | | $59.71 | $125.62 | $237.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.91 / $181.14 / $413.90
| Professional | | $144.91 | $181.14 | $413.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $78.62 / $180.45 / $386.58
| Facility | | $78.62 | $180.45 | $386.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.77 / $407.23 / $1,090.24
| Professional | | $176.77 | $407.23 | $1,090.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $164.52 / $327.41 / $1,239.49
| Facility | | $164.52 | $327.41 | $1,239.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.19 / $214.83 / $400.46
| Professional | | $149.19 | $214.83 | $400.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.73 / $211.25 / $283.33
| Professional | | $112.73 | $211.25 | $283.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $2,000.00 / $2,000.00
| Facility | | $2,000.00 | $2,000.00 | $2,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.97 / $294.62 / $425.46
| Professional | | $134.97 | $294.62 | $425.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.50 / $148.69 / $317.70
| Professional | | $121.50 | $148.69 | $317.70 |