- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $84.04 / $84.81 / $84.81
| Facility | | $84.04 | $84.81 | $84.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.22 / $60.81 / $102.36
| Professional | | $45.22 | $60.81 | $102.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.22 / $66.22 / $148.50
| Facility | | $66.22 | $66.22 | $148.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.22 / $117.38 / $148.50
| Professional | | $66.22 | $117.38 | $148.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.25 / $124.45 / $135.00
| Professional | | $101.25 | $124.45 | $135.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $86.09 / $162.00 / $551.54
| Facility | | $86.09 | $162.00 | $551.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.08 / $75.77 / $184.45
| Professional | | $60.08 | $75.77 | $184.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $148.06 / $148.50 / $177.97
| Facility | | $148.06 | $148.50 | $177.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.22 / $159.91 / $283.77
| Professional | | $116.22 | $159.91 | $283.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.51 / $67.34 / $158.80
| Professional | | $50.51 | $67.34 | $158.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.30 / $132.30 / $132.30
| Facility | | $132.30 | $132.30 | $132.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.52 / $132.30 / $132.30
| Professional | | $104.52 | $132.30 | $132.30 |