- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.63 / $267.88 / $3,417.56
| Facility | | $115.63 | $267.88 | $3,417.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.57 / $204.74 / $701.55
| Professional | | $113.57 | $204.74 | $701.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $103.70 / $122.00 / $8,639.91
| Facility | | $103.70 | $122.00 | $8,639.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.70 / $116.70 / $116.70
| Professional | | $116.70 | $116.70 | $116.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.09 / $112.45 / $112.45
| Facility | | $106.09 | $112.45 | $112.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.45 / $112.45 / $112.45
| Professional | | $112.45 | $112.45 | $112.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $411.11 / $411.11 / $411.11
| Facility | | $411.11 | $411.11 | $411.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.63 / $283.91 / $3,402.50
| Facility | | $115.63 | $283.91 | $3,402.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.57 / $246.40 / $569.72
| Professional | | $115.57 | $246.40 | $569.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.09 / $112.45 / $112.45
| Facility | | $106.09 | $112.45 | $112.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.45 / $112.45 / $112.45
| Professional | | $112.45 | $112.45 | $112.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $129.58 / $129.58 / $150.37
| Facility | | $129.58 | $129.58 | $150.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.58 / $129.58 / $150.37
| Professional | | $129.58 | $129.58 | $150.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $139.66 / $139.66 / $139.66
| Facility | | $139.66 | $139.66 | $139.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.45 / $112.45 / $205.78
| Professional | | $112.45 | $112.45 | $205.78 |