- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.22 / $59.22 / $59.22
| Facility | | $59.22 | $59.22 | $59.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.22 / $62.07 / $104.83
| Professional | | $59.22 | $62.07 | $104.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.06 / $338.46 / $715.54
| Facility | | $64.06 | $338.46 | $715.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.02 / $103.22 / $132.38
| Professional | | $61.02 | $103.22 | $132.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $78.41 / $78.41 / $232.88
| Facility | | $78.41 | $78.41 | $232.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.77 / $111.47 / $111.47
| Professional | | $88.77 | $111.47 | $111.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $78.41 / $99.64 / $112.36
| Facility | | $78.41 | $99.64 | $112.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.02 / $112.36 / $193.13
| Professional | | $82.02 | $112.36 | $193.13 |
- 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
- $109.75 / $109.75 / $115.24
| Professional | | $109.75 | $109.75 | $115.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.90 / $85.90 / $85.90
| Professional | | $85.90 | $85.90 | $85.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.46 / $715.54 / $715.54
| Facility | | $338.46 | $715.54 | $715.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.97 / $72.45 / $132.38
| Professional | | $51.97 | $72.45 | $132.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.16 / $72.45 / $138.83
| Professional | | $57.16 | $72.45 | $138.83 |