- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $83.18 / $83.18
| Facility | | $83.18 | $83.18 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $83.18 / $134.90
| Professional | | $56.23 | $83.18 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $134.90 / $537.03
| Facility | | $120.23 | $134.90 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $120.23 / $165.96
| Professional | | $67.61 | $120.23 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $7,413.10 / $22,387.21
| Facility | | $7,413.10 | $7,413.10 | $22,387.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $123.03 / $131.83
| Professional | | $123.03 | $123.03 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $128.82 / $128.82
| Facility | | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $93.33 / $128.82
| Professional | | $93.33 | $93.33 | $128.82 |
- 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
- $107.15 / $107.15 / $162.18
| Professional | | $107.15 | $107.15 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $89.13 / $89.13
| Professional | | $89.13 | $89.13 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $134.90 / $537.03
| Facility | | $120.23 | $134.90 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $120.23 / $165.96
| Professional | | $67.61 | $120.23 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.14 / $95.50 / $194.98
| Facility | | $0.14 | $95.50 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $107.15 / $144.54
| Professional | | $67.61 | $107.15 | $144.54 |