- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.20 / $187.08 / $187.08
| Facility | | $75.20 | $187.08 | $187.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.89 / $165.07 / $194.57
| Professional | | $67.89 | $165.07 | $194.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.55 / $238.07 / $556.08
| Professional | | $163.55 | $238.07 | $556.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.52 / $222.20 / $489.35
| Facility | | $97.52 | $222.20 | $489.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.03 / $375.02 / $1,408.08
| Professional | | $214.03 | $375.02 | $1,408.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.36 / $305.57 / $497.28
| Facility | | $190.36 | $305.57 | $497.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.31 / $352.38 / $497.28
| Professional | | $178.31 | $352.38 | $497.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.72 / $260.33 / $365.76
| Professional | | $134.72 | $260.33 | $365.76 |
- 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
- $206.26 / $348.32 / $541.83
| Professional | | $206.26 | $348.32 | $541.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.19 / $192.40 / $453.10
| Professional | | $157.19 | $192.40 | $453.10 |