- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $82.07 / $82.07 / $82.07
| Facility | | $82.07 | $82.07 | $82.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.02 / $82.07 / $120.29
| Professional | | $57.02 | $82.07 | $120.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $168.04 / $556.72 / $899.40
| Facility | | $168.04 | $556.72 | $899.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.87 / $136.02 / $183.42
| Professional | | $77.87 | $136.02 | $183.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.02 / $190.53 / $263.77
| Professional | | $127.02 | $190.53 | $263.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.42 / $107.42 / $153.94
| Facility | | $107.42 | $107.42 | $153.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.42 / $107.42 / $223.13
| Professional | | $78.42 | $107.42 | $223.13 |
- 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
- $152.07 / $152.07 / $159.66
| Professional | | $152.07 | $152.07 | $159.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.42 / $114.42 / $114.42
| Professional | | $114.42 | $114.42 | $114.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $390.69 / $899.40 / $899.40
| Facility | | $390.69 | $899.40 | $899.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.47 / $93.70 / $183.42
| Professional | | $71.47 | $93.70 | $183.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.14 / $85.00 / $91.26
| Facility | | $0.14 | $85.00 | $91.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.37 / $93.70 / $183.42
| Professional | | $73.37 | $93.70 | $183.42 |