- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.10 / $218.78 / $398.11
| Facility | | $87.10 | $218.78 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $87.10 / $234.42
| Professional | | $67.61 | $87.10 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $128.82 / $323.59
| Facility | | $83.18 | $128.82 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $95.50 / $316.23
| Professional | | $56.23 | $95.50 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $223.87 / $323.59
| Facility | | $181.97 | $223.87 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $89.13 / $93.33
| Professional | | $89.13 | $89.13 | $93.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.13 / $128.82 / $199.53
| Facility | | $74.13 | $128.82 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $91.20 / $245.47
| Professional | | $56.23 | $91.20 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $138.04 / $162.18
| Professional | | $138.04 | $138.04 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $95.50 / $199.53
| Professional | | $95.50 | $95.50 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $107.15 / $223.87
| Facility | | $107.15 | $107.15 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $128.82 / $323.59
| Facility | | $83.18 | $128.82 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $95.50 / $354.81
| Professional | | $56.23 | $95.50 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.86 / $95.50 / $151.36
| Facility | | $75.86 | $95.50 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $95.50 / $194.98
| Professional | | $56.23 | $95.50 | $194.98 |