- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.80 / $128.80 / $128.80
| Facility | | $128.80 | $128.80 | $128.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.80 / $141.97 / $185.18
| Professional | | $128.80 | $141.97 | $185.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.09 / $607.39 / $1,866.94
| Facility | | $80.09 | $607.39 | $1,866.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.64 / $224.46 / $287.87
| Professional | | $124.64 | $224.46 | $287.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $170.51 / $170.51 / $506.41
| Facility | | $170.51 | $170.51 | $506.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.03 / $243.66 / $243.66
| Professional | | $193.03 | $243.66 | $243.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $170.51 / $190.69 / $206.67
| Facility | | $170.51 | $190.69 | $206.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.19 / $190.69 / $341.63
| Professional | | $139.19 | $190.69 | $341.63 |
- 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
- $238.67 / $238.67 / $250.60
| Professional | | $238.67 | $238.67 | $250.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $187.29 / $187.29 / $187.29
| Facility | | $187.29 | $187.29 | $187.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.29 / $187.29 / $187.29
| Professional | | $187.29 | $187.29 | $187.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $607.39 / $1,866.94 / $1,866.94
| Facility | | $607.39 | $1,866.94 | $1,866.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.31 / $157.58 / $287.87
| Professional | | $113.31 | $157.58 | $287.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.84 / $157.58 / $331.97
| Professional | | $121.84 | $157.58 | $331.97 |