- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.28 / $109.65 / $588.84
| Facility | | $81.28 | $109.65 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $123.03 / $234.42
| Professional | | $91.20 | $123.03 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $112.20 / $141.25
| Professional | | $87.10 | $112.20 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $524.81 / $524.81
| Facility | | $478.63 | $524.81 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $147.91 / $239.88
| Professional | | $100.00 | $147.91 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $177.83 / $177.83
| Facility | | $177.83 | $177.83 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $134.90 / $194.98
| Professional | | $97.72 | $134.90 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $158.49 / $309.03
| Professional | | $100.00 | $158.49 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $33.11
| Professional | | $32.36 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,000.00 / $1,288.25
| Facility | | $562.34 | $1,000.00 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $147.91 / $239.88
| Professional | | $107.15 | $147.91 | $239.88 |