- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.03 / $236.65 / $236.65
| Facility | | $57.03 | $236.65 | $236.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.10 / $190.06 / $385.81
| Professional | | $56.10 | $190.06 | $385.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.52 / $201.54 / $627.17
| Professional | | $119.52 | $201.54 | $627.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.59 / $246.16 / $602.90
| Facility | | $80.59 | $246.16 | $602.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.37 / $538.03 / $1,617.12
| Professional | | $207.37 | $538.03 | $1,617.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $137.05 / $505.41 / $1,664.46
| Facility | | $137.05 | $505.41 | $1,664.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.54 / $354.96 / $605.29
| Professional | | $120.54 | $354.96 | $605.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.03 / $290.18 / $412.72
| Professional | | $94.03 | $290.18 | $412.72 |
- 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
- $261.33 / $435.44 / $677.35
| Professional | | $261.33 | $435.44 | $677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.70 / $134.30 / $501.00
| Professional | | $109.70 | $134.30 | $501.00 |