- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $68.00 / $68.00 / $68.00
| Facility | | $68.00 | $68.00 | $68.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.00 / $68.00 / $92.30
| Professional | | $68.00 | $68.00 | $92.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $90.77 / $324.25 / $835.62
| Facility | | $90.77 | $324.25 | $835.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.79 / $104.39 / $151.97
| Professional | | $60.79 | $104.39 | $151.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $90.03 / $90.03 / $267.39
| Facility | | $90.03 | $90.03 | $267.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.91 / $105.25 / $105.25
| Professional | | $101.91 | $105.25 | $105.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $90.03 / $103.32 / $109.11
| Facility | | $90.03 | $103.32 | $109.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.42 / $103.32 / $185.25
| Professional | | $75.42 | $103.32 | $185.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.00 / $126.00 / $132.30
| Professional | | $126.00 | $126.00 | $132.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.83 / $83.83 / $83.83
| Professional | | $83.83 | $83.83 | $83.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $324.25 / $835.62 / $835.62
| Facility | | $324.25 | $835.62 | $835.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.85 / $77.64 / $151.97
| Professional | | $54.85 | $77.64 | $151.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.79 / $77.64 / $131.94
| Professional | | $55.79 | $77.64 | $131.94 |