- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.47 / $81.47 / $81.47
| Facility | | $81.47 | $81.47 | $81.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.47 / $106.85 / $155.10
| Professional | | $81.47 | $106.85 | $155.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.56 / $415.98 / $889.53
| Facility | | $125.56 | $415.98 | $889.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.38 / $133.57 / $182.06
| Professional | | $84.38 | $133.57 | $182.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,077.73 / $1,077.73 / $3,200.86
| Facility | | $1,077.73 | $1,077.73 | $3,200.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.61 / $181.39 / $240.74
| Professional | | $120.61 | $181.39 | $240.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $118.47 / $120.81 / $120.81
| Facility | | $118.47 | $120.81 | $120.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.19 / $120.81 / $221.63
| Professional | | $88.19 | $120.81 | $221.63 |
- 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
- $150.94 / $150.94 / $158.50
| Professional | | $150.94 | $150.94 | $158.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.76 / $95.76 / $102.12
| Facility | | $95.76 | $95.76 | $102.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.76 / $95.76 / $116.74
| Professional | | $95.76 | $95.76 | $116.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $387.81 / $889.53 / $889.53
| Facility | | $387.81 | $889.53 | $889.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.79 / $94.85 / $182.06
| Professional | | $66.79 | $94.85 | $182.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.81 / $101.27 / $182.06
| Professional | | $72.81 | $101.27 | $182.06 |