- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $84.13 / $84.13 / $84.13
| Facility | | $84.13 | $84.13 | $84.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.13 / $86.76 / $126.09
| Professional | | $84.13 | $86.76 | $126.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $96.11 / $365.68 / $947.19
| Facility | | $96.11 | $365.68 | $947.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.59 / $138.49 / $188.05
| Professional | | $81.59 | $138.49 | $188.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $111.38 / $111.38 / $330.80
| Facility | | $111.38 | $111.38 | $330.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.09 / $159.54 / $159.54
| Professional | | $126.09 | $159.54 | $159.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $111.38 / $116.53 / $134.99
| Facility | | $111.38 | $116.53 | $134.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.07 / $85.07 / $208.88
| Professional | | $85.07 | $85.07 | $208.88 |
- 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
- $155.90 / $155.90 / $163.69
| Professional | | $155.90 | $155.90 | $163.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.92 / $112.92 / $112.92
| Professional | | $112.92 | $112.92 | $112.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $365.68 / $947.19 / $947.19
| Facility | | $365.68 | $947.19 | $947.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.31 / $96.07 / $188.05
| Professional | | $73.31 | $96.07 | $188.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.72 / $91.72 / $91.72
| Facility | | $91.72 | $91.72 | $91.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.17 / $102.93 / $180.14
| Professional | | $76.17 | $102.93 | $180.14 |