- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $73.66 / $73.66 / $73.66
| Facility | | $73.66 | $73.66 | $73.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.66 / $81.18 / $107.95
| Professional | | $73.66 | $81.18 | $107.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.25 / $394.25 / $804.26
| Facility | | $131.25 | $394.25 | $804.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.89 / $125.00 / $164.61
| Professional | | $69.89 | $125.00 | $164.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $135.31 / $135.31 / $401.87
| Facility | | $135.31 | $135.31 | $401.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.39 / $140.35 / $140.35
| Professional | | $110.39 | $140.35 | $140.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.56 / $104.24 / $118.17
| Facility | | $59.56 | $104.24 | $118.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.09 / $104.24 / $200.25
| Professional | | $76.09 | $104.24 | $200.25 |
- 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
- $136.47 / $136.47 / $143.30
| Professional | | $136.47 | $136.47 | $143.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $195.56 / $195.56 / $195.56
| Facility | | $195.56 | $195.56 | $195.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.77 / $104.77 / $104.77
| Professional | | $104.77 | $104.77 | $104.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.62 / $804.26 / $804.26
| Facility | | $350.62 | $804.26 | $804.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.15 / $84.10 / $164.61
| Professional | | $64.15 | $84.10 | $164.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.23 / $90.11 / $164.61
| Professional | | $65.23 | $90.11 | $164.61 |