- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.05 / $109.05 / $109.05
| Facility | | $109.05 | $109.05 | $109.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.05 / $121.29 / $162.32
| Professional | | $109.05 | $121.29 | $162.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.42 / $582.45 / $1,580.75
| Facility | | $126.42 | $582.45 | $1,580.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.43 / $190.05 / $243.74
| Professional | | $112.43 | $190.05 | $243.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.36 / $144.36 / $428.75
| Facility | | $144.36 | $144.36 | $428.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.43 / $205.24 / $205.24
| Professional | | $163.43 | $205.24 | $205.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.36 / $183.45 / $185.61
| Facility | | $144.36 | $183.45 | $185.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.50 / $185.61 / $332.63
| Professional | | $135.50 | $185.61 | $332.63 |
- 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
- $202.08 / $202.08 / $212.18
| Professional | | $202.08 | $202.08 | $212.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.57 / $158.57 / $158.57
| Professional | | $158.57 | $158.57 | $158.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $582.45 / $1,580.75 / $1,580.75
| Facility | | $582.45 | $1,580.75 | $1,580.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.94 / $133.41 / $243.74
| Professional | | $95.94 | $133.41 | $243.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $195.26 / $195.26 / $195.26
| Facility | | $195.26 | $195.26 | $195.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.16 / $133.41 / $243.74
| Professional | | $103.16 | $133.41 | $243.74 |