- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.54 / $95.63 / $95.63
| Facility | | $91.54 | $95.63 | $95.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.46 / $95.63 / $115.32
| Professional | | $88.46 | $95.63 | $115.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,459.92 / $8,639.91 / $79,506.39
| Facility | | $8,459.92 | $8,639.91 | $79,506.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.47 / $123.98 / $225.81
| Professional | | $119.47 | $123.98 | $225.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.66 / $138.66 / $138.66
| Facility | | $138.66 | $138.66 | $138.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.45 / $104.45 / $104.45
| Professional | | $104.45 | $104.45 | $104.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $254.54 / $254.54 / $254.54
| Facility | | $254.54 | $254.54 | $254.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.33 / $172.02 / $239.98
| Professional | | $133.33 | $172.02 | $239.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.54 / $95.63 / $95.63
| Facility | | $91.54 | $95.63 | $95.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.46 / $98.54 / $120.62
| Professional | | $88.46 | $98.54 | $120.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.10 / $282.80 / $282.80
| Professional | | $230.10 | $282.80 | $282.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.66 / $138.66 / $138.66
| Facility | | $138.66 | $138.66 | $138.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.45 / $104.45 / $104.45
| Professional | | $104.45 | $104.45 | $104.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $116.94 / $116.94 / $136.13
| Facility | | $116.94 | $116.94 | $136.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.41 / $118.59 / $119.34
| Professional | | $112.41 | $118.59 | $119.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.49 / $136.96 / $229.57
| Professional | | $105.49 | $136.96 | $229.57 |