- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $90.08 / $90.08 / $90.08
| Facility | | $90.08 | $90.08 | $90.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.25 / $100.64 / $132.30
| Professional | | $84.25 | $100.64 | $132.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.91 / $587.28 / $939.42
| Facility | | $160.91 | $587.28 | $939.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.68 / $147.55 / $201.33
| Professional | | $81.68 | $147.55 | $201.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.82 / $266.22 / $342.84
| Facility | | $218.82 | $266.22 | $342.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.80 / $139.41 / $139.41
| Professional | | $118.80 | $139.41 | $139.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.67 / $119.14 / $144.53
| Facility | | $112.67 | $119.14 | $144.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.25 / $112.67 / $234.38
| Professional | | $82.25 | $112.67 | $234.38 |
- 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
- $166.92 / $166.92 / $175.27
| Professional | | $166.92 | $166.92 | $175.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.29 / $120.29 / $120.29
| Facility | | $120.29 | $120.29 | $120.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.25 / $120.25 / $120.29
| Professional | | $120.25 | $120.25 | $120.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $410.45 / $939.42 / $939.42
| Facility | | $410.45 | $939.42 | $939.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.95 / $102.85 / $201.33
| Professional | | $74.95 | $102.85 | $201.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.56 / $102.85 / $197.31
| Professional | | $68.56 | $102.85 | $197.31 |