- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.70 / $114.70 / $114.70
| Facility | | $114.70 | $114.70 | $114.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.07 / $124.13 / $347.71
| Professional | | $95.07 | $124.13 | $347.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $253.38 / $560.79 / $560.79
| Facility | | $253.38 | $560.79 | $560.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.21 / $204.71 / $1,082.00
| Professional | | $119.21 | $204.71 | $1,082.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.81 / $214.40 / $334.09
| Professional | | $141.81 | $214.40 | $334.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.90 / $132.90 / $132.90
| Facility | | $132.90 | $132.90 | $132.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.40 / $176.97 / $330.36
| Professional | | $113.40 | $176.97 | $330.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $135.52 / $135.52 / $135.52
| Facility | | $135.52 | $135.52 | $135.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.56 / $120.77 / $208.03
| Professional | | $65.56 | $120.77 | $208.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.49 / $277.33 / $358.11
| Professional | | $140.49 | $277.33 | $358.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.78 / $348.36 / $871.25
| Professional | | $180.78 | $348.36 | $871.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $253.38 / $560.79 / $560.79
| Facility | | $253.38 | $560.79 | $560.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.55 / $189.90 / $1,082.00
| Professional | | $129.55 | $189.90 | $1,082.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.15 / $116.43 / $208.94
| Professional | | $86.15 | $116.43 | $208.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.33 / $176.85 / $323.85
| Professional | | $125.33 | $176.85 | $323.85 |