- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $111.05 / $111.05 / $111.05
| Facility | | $111.05 | $111.05 | $111.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.05 / $111.05 / $143.11
| Professional | | $111.05 | $111.05 | $143.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $136.50 / $427.42 / $1,234.72
| Facility | | $136.50 | $427.42 | $1,234.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.53 / $159.59 / $248.19
| Professional | | $98.53 | $159.59 | $248.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.01 / $147.01 / $436.62
| Facility | | $147.01 | $147.01 | $436.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.42 / $195.94 / $195.94
| Professional | | $166.42 | $195.94 | $195.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $136.19 / $147.01 / $178.18
| Facility | | $136.19 | $147.01 | $178.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.43 / $136.19 / $244.13
| Professional | | $99.43 | $136.19 | $244.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.77 / $205.77 / $216.06
| Professional | | $205.77 | $205.77 | $216.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.58 / $137.58 / $137.58
| Professional | | $137.58 | $137.58 | $137.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $427.42 / $1,234.72 / $1,234.72
| Facility | | $427.42 | $1,234.72 | $1,234.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.53 / $126.79 / $248.19
| Professional | | $84.53 | $126.79 | $248.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.10 / $63.10 / $63.10
| Facility | | $63.10 | $63.10 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.28 / $126.79 / $205.77
| Professional | | $85.28 | $126.79 | $205.77 |