- 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
- $74.13 / $102.33 / $213.80
| Professional | | $74.13 | $102.33 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $199.53 / $954.99
| Facility | | $151.36 | $199.53 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $144.54 / $199.53
| Professional | | $81.28 | $144.54 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $112.20 / $338.84
| Facility | | $112.20 | $112.20 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $158.49 / $158.49
| Professional | | $125.89 | $158.49 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $117.49 / $134.90
| Facility | | $112.20 | $117.49 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $85.11 / $117.49
| Professional | | $85.11 | $85.11 | $117.49 |
- 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
- $169.82 / $169.82 / $257.04
| Professional | | $169.82 | $169.82 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $112.20 / $112.20
| Professional | | $112.20 | $112.20 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $199.53 / $954.99
| Facility | | $151.36 | $199.53 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $147.91 / $199.53
| Professional | | $81.28 | $147.91 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.14 / $100.00 / $245.47
| Facility | | $0.14 | $100.00 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $114.82 / $169.82
| Professional | | $75.86 | $114.82 | $169.82 |