- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $78.37 / $110.56 / $7,831.71
| Facility | | $78.37 | $110.56 | $7,831.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.37 / $78.37 / $94.95
| Professional | | $78.37 | $78.37 | $94.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $69.09 / $210.03 / $391.85
| Facility | | $69.09 | $210.03 | $391.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.37 / $82.29 / $933.66
| Professional | | $78.37 | $82.29 | $933.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $84.01 / $96.24 / $176.72
| Facility | | $84.01 | $96.24 | $176.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.09 / $78.37 / $78.37
| Facility | | $77.09 | $78.37 | $78.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.37 / $78.37 / $83.71
| Professional | | $78.37 | $78.37 | $83.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $78.47 / $123.98 / $8,090.00
| Facility | | $78.47 | $123.98 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.37 / $78.37 / $78.37
| Professional | | $78.37 | $78.37 | $78.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.37 / $78.37 / $90.71
| Professional | | $78.37 | $78.37 | $90.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $529.97 / $662.46 / $8,201.65
| Facility | | $529.97 | $662.46 | $8,201.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.24 / $391.85 / $391.85
| Facility | | $104.24 | $391.85 | $391.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.37 / $83.07 / $933.66
| Professional | | $78.37 | $83.07 | $933.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.49 / $56.40 / $90.58
| Facility | | $50.49 | $56.40 | $90.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.37 / $82.29 / $101.51
| Professional | | $78.37 | $82.29 | $101.51 |