- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $98.68 / $98.68 / $98.68
| Facility | | $98.68 | $98.68 | $98.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.68 / $103.69 / $141.87
| Professional | | $98.68 | $103.69 | $141.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $96.11 / $637.27 / $1,430.27
| Facility | | $96.11 | $637.27 | $1,430.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.11 / $171.96 / $220.54
| Professional | | $96.11 | $171.96 | $220.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.63 / $130.63 / $387.97
| Facility | | $130.63 | $130.63 | $387.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.88 / $173.72 / $173.72
| Professional | | $147.88 | $173.72 | $173.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.63 / $141.12 / $158.32
| Facility | | $130.63 | $141.12 | $158.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.02 / $103.02 / $261.75
| Professional | | $103.02 | $103.02 | $261.75 |
- 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
- $182.85 / $182.85 / $191.99
| Professional | | $182.85 | $182.85 | $191.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.47 / $143.47 / $143.47
| Professional | | $143.47 | $143.47 | $143.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,069.63 / $1,430.27 / $1,430.27
| Facility | | $1,069.63 | $1,430.27 | $1,430.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.81 / $120.72 / $220.54
| Professional | | $86.81 | $120.72 | $220.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.50 / $150.50 / $150.50
| Facility | | $150.50 | $150.50 | $150.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.49 / $120.72 / $254.33
| Professional | | $95.49 | $120.72 | $254.33 |