- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.20 / $100.20 / $100.20
| Facility | | $100.20 | $100.20 | $100.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.13 / $100.20 / $148.40
| Professional | | $84.13 | $100.20 | $148.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.02 / $222.26 / $486.50
| Facility | | $105.02 | $222.26 | $486.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.09 / $133.04 / $389.82
| Professional | | $84.09 | $133.04 | $389.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $238.91 / $273.32 / $354.24
| Facility | | $238.91 | $273.32 | $354.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.89 / $112.89 / $112.89
| Professional | | $112.89 | $112.89 | $112.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $88.00 / $115.00 / $127.92
| Facility | | $88.00 | $115.00 | $127.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.19 / $150.47 / $282.50
| Professional | | $89.19 | $150.47 | $282.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $96.52 / $145.02 / $6,679.00
| Facility | | $96.52 | $145.02 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.38 / $90.57 / $154.38
| Professional | | $55.38 | $90.57 | $154.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.96 / $208.22 / $295.83
| Professional | | $100.96 | $208.22 | $295.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $145.94 / $145.94 / $145.94
| Facility | | $145.94 | $145.94 | $145.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $222.26 / $486.50 / $486.50
| Facility | | $222.26 | $486.50 | $486.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.97 / $142.83 / $616.10
| Professional | | $90.97 | $142.83 | $616.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.97 / $133.04 / $274.10
| Professional | | $90.97 | $133.04 | $274.10 |