- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.38 / $100.38 / $100.38
| Facility | | $100.38 | $100.38 | $100.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.20 / $107.03 / $128.00
| Professional | | $97.20 | $107.03 | $128.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $8,639.91 / $79,506.39
| Facility | | $5,000.00 | $8,639.91 | $79,506.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.16 / $167.26 / $247.87
| Professional | | $161.16 | $167.26 | $247.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.22 / $145.22 / $145.22
| Professional | | $145.22 | $145.22 | $145.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.58 / $249.58 / $249.58
| Professional | | $249.58 | $249.58 | $249.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.38 / $100.38 / $100.38
| Facility | | $100.38 | $100.38 | $100.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.20 / $108.51 / $130.31
| Professional | | $97.20 | $108.51 | $130.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.22 / $145.22 / $145.22
| Professional | | $145.22 | $145.22 | $145.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $124.50 / $124.50 / $142.66
| Facility | | $124.50 | $124.50 | $142.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.92 / $124.94 / $142.66
| Professional | | $120.92 | $124.94 | $142.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.31 / $161.84 / $242.46
| Professional | | $117.31 | $161.84 | $242.46 |