- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $119.58 / $119.58 / $119.58
| Facility | | $119.58 | $119.58 | $119.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.81 / $125.34 / $377.37
| Professional | | $97.81 | $125.34 | $377.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.35 / $582.29 / $582.29
| Facility | | $263.35 | $582.29 | $582.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.74 / $212.37 / $1,082.00
| Professional | | $123.74 | $212.37 | $1,082.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.86 / $222.57 / $346.79
| Professional | | $143.86 | $222.57 | $346.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.29 / $138.29 / $138.29
| Facility | | $138.29 | $138.29 | $138.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.00 / $184.26 / $343.03
| Professional | | $118.00 | $184.26 | $343.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.69 / $140.69 / $140.69
| Facility | | $140.69 | $140.69 | $140.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.06 / $125.37 / $216.91
| Professional | | $68.06 | $125.37 | $216.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.82 / $287.85 / $371.70
| Professional | | $145.82 | $287.85 | $371.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.12 / $363.31 / $363.31
| Professional | | $188.12 | $363.31 | $363.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.35 / $582.29 / $582.29
| Facility | | $263.35 | $582.29 | $582.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.44 / $198.51 / $1,082.00
| Professional | | $133.44 | $198.51 | $1,082.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.75 / $121.55 / $218.12
| Professional | | $92.75 | $121.55 | $218.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.38 / $183.38 / $319.94
| Professional | | $130.38 | $183.38 | $319.94 |