- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $123.03 / $123.03
| Facility | | $123.03 | $123.03 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $123.03 / $239.88
| Professional | | $85.11 | $123.03 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $288.40 / $1,318.26
| Facility | | $251.19 | $288.40 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $199.53 / $288.40
| Professional | | $104.71 | $199.53 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $162.18 / $489.78
| Facility | | $162.18 | $162.18 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $213.80 / $213.80
| Professional | | $181.97 | $213.80 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $162.18 / $194.98
| Facility | | $141.25 | $162.18 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $102.33 / $144.54
| Professional | | $102.33 | $102.33 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $245.47 / $371.54
| Professional | | $245.47 | $245.47 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $134.90 / $134.90
| Professional | | $134.90 | $134.90 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $288.40 / $1,318.26
| Facility | | $251.19 | $288.40 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $213.80 / $288.40
| Professional | | $104.71 | $213.80 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.17 / $134.90 / $288.40
| Facility | | $0.17 | $134.90 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $147.91 / $245.47
| Professional | | $102.33 | $147.91 | $245.47 |