- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $190.55 / $1,862.09
| Facility | | $83.18 | $190.55 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $102.33 / $537.03
| Professional | | $81.28 | $102.33 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $275.42 / $724.44
| Facility | | $91.20 | $275.42 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $87.10 / $213.80
| Professional | | $85.11 | $87.10 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $269.15 / $426.58
| Facility | | $154.88 | $269.15 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $151.36 / $316.23
| Professional | | $125.89 | $151.36 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.10 / $87.10 / $87.10
| Facility | | $87.10 | $87.10 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $87.10 / $87.10
| Professional | | $87.10 | $87.10 | $87.10 |
- 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
- $87.10 / $87.10 / $144.54
| Professional | | $87.10 | $87.10 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $275.42 / $724.44
| Facility | | $91.20 | $275.42 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $87.10 / $218.78
| Professional | | $85.11 | $87.10 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.25 / $6.76 / $120.23
| Professional | | $5.25 | $6.76 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.11 / $263.03 / $338.84
| Facility | | $85.11 | $263.03 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $87.10 / $120.23
| Professional | | $85.11 | $87.10 | $120.23 |