- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $76.22 / $76.22 / $76.22
| Facility | | $76.22 | $76.22 | $76.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.22 / $76.22 / $103.47
| Professional | | $76.22 | $76.22 | $103.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $96.11 / $315.18 / $876.23
| Facility | | $96.11 | $315.18 | $876.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.14 / $114.87 / $170.36
| Professional | | $68.14 | $114.87 | $170.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $185.16 / $225.27 / $290.11
| Facility | | $185.16 | $225.27 | $290.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.24 / $125.84 / $125.84
| Professional | | $114.24 | $125.84 | $125.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.43 / $100.91 / $122.31
| Facility | | $100.43 | $100.91 | $122.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.31 / $100.43 / $180.00
| Professional | | $73.31 | $100.43 | $180.00 |
- 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
- $141.25 / $141.25 / $148.31
| Professional | | $141.25 | $141.25 | $148.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.23 / $92.23 / $92.23
| Professional | | $92.23 | $92.23 | $92.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $315.18 / $876.23 / $876.23
| Facility | | $315.18 | $876.23 | $876.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.36 / $87.03 / $170.36
| Professional | | $60.36 | $87.03 | $170.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.39 / $87.03 / $145.16
| Professional | | $61.39 | $87.03 | $145.16 |