- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.58 / $143.10 / $143.10
| Facility | | $105.58 | $143.10 | $143.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.58 / $143.10 / $213.94
| Professional | | $105.58 | $143.10 | $213.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.35 / $318.04 / $421.69
| Professional | | $186.35 | $318.04 | $421.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.98 / $207.24 / $392.97
| Facility | | $120.98 | $207.24 | $392.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.74 / $317.52 / $1,090.08
| Professional | | $169.74 | $317.52 | $1,090.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $216.65 / $273.63 / $391.32
| Facility | | $216.65 | $273.63 | $391.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.32 / $282.72 / $372.31
| Professional | | $222.32 | $282.72 | $372.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.78 / $216.71 / $280.18
| Professional | | $149.78 | $216.71 | $280.18 |
- 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
- $166.32 / $278.52 / $416.22
| Professional | | $166.32 | $278.52 | $416.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.00 / $263.00 / $343.10
| Professional | | $215.00 | $263.00 | $343.10 |