- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $84.04 / $84.04 / $84.04
| Facility | | $84.04 | $84.04 | $84.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.04 / $84.04 / $111.77
| Professional | | $84.04 | $84.04 | $111.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.13 / $359.39 / $955.70
| Facility | | $112.13 | $359.39 | $955.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.70 / $119.40 / $187.84
| Professional | | $73.70 | $119.40 | $187.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $111.24 / $111.24 / $330.38
| Facility | | $111.24 | $111.24 | $330.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.94 / $160.13 / $160.13
| Professional | | $125.94 | $160.13 | $160.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.79 / $111.24 / $134.83
| Facility | | $97.79 | $111.24 | $134.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.39 / $97.79 / $205.13
| Professional | | $71.39 | $97.79 | $205.13 |
- 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
- $155.74 / $155.74 / $163.53
| Professional | | $155.74 | $155.74 | $163.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.87 / $95.87 / $95.87
| Professional | | $95.87 | $95.87 | $95.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $359.39 / $955.70 / $955.70
| Facility | | $359.39 | $955.70 | $955.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.98 / $95.96 / $187.84
| Professional | | $63.98 | $95.96 | $187.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.12 / $74.61 / $85.37
| Facility | | $0.12 | $74.61 | $85.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.04 / $95.96 / $155.74
| Professional | | $68.04 | $95.96 | $155.74 |