- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.33 / $95.50 / $109.65
| Facility | | $93.33 | $95.50 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $93.33 / $123.03
| Professional | | $70.79 | $93.33 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.54 / $34.67 / $95.50
| Facility | | $27.54 | $34.67 | $95.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.49 / $120.23 / $125.89
| Facility | | $117.49 | $120.23 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $154.88 / $186.21
| Professional | | $147.91 | $154.88 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $141.25 / $229.09
| Facility | | $141.25 | $141.25 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $194.98 / $229.09
| Professional | | $147.91 | $194.98 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $33.11
| Professional | | $30.20 | $30.20 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $245.47 / $302.00
| Professional | | $204.17 | $245.47 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $151.36 / $398.11
| Facility | | $120.23 | $151.36 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $125.89 / $125.89
| Professional | | $125.89 | $125.89 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $125.89 / $125.89
| Professional | | $125.89 | $125.89 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $125.89 / $125.89
| Professional | | $120.23 | $125.89 | $125.89 |