- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.29 / $77.29 / $77.29
| Facility | | $77.29 | $77.29 | $77.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.29 / $77.29 / $101.49
| Professional | | $77.29 | $77.29 | $101.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.25 / $448.96 / $840.28
| Facility | | $131.25 | $448.96 | $840.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.81 / $125.00 / $172.76
| Professional | | $64.81 | $125.00 | $172.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.31 / $102.31 / $303.86
| Facility | | $102.31 | $102.31 | $303.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.84 / $145.47 / $145.47
| Professional | | $115.84 | $145.47 | $145.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.31 / $106.22 / $124.01
| Facility | | $102.31 | $106.22 | $124.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.54 / $106.22 / $187.88
| Professional | | $77.54 | $106.22 | $187.88 |
- 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
- $143.22 / $143.22 / $150.38
| Professional | | $143.22 | $143.22 | $150.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.29 / $84.29 / $84.29
| Professional | | $84.29 | $84.29 | $84.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $448.96 / $840.28 / $840.28
| Facility | | $448.96 | $840.28 | $840.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.84 / $88.25 / $172.76
| Professional | | $58.84 | $88.25 | $172.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.11 / $55.16 / $73.48
| Facility | | $0.11 | $55.16 | $73.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.84 / $88.25 / $143.22
| Professional | | $58.84 | $88.25 | $143.22 |