- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.13 / $89.13 / $89.13
| Facility | | $89.13 | $89.13 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $114.82 / $263.03
| Professional | | $85.11 | $114.82 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $213.80 / $933.25
| Facility | | $194.98 | $213.80 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $151.36 / $213.80
| Professional | | $89.13 | $151.36 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $489.78 / $1,479.11
| Facility | | $489.78 | $489.78 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $186.21 / $245.47
| Professional | | $134.90 | $186.21 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $125.89 / $125.89
| Facility | | $107.15 | $125.89 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $93.33 / $125.89
| Professional | | $93.33 | $93.33 | $125.89 |
- 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
- $181.97 / $181.97 / $275.42
| Professional | | $181.97 | $181.97 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $128.82 / $128.82
| Professional | | $100.00 | $128.82 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $213.80 / $933.25
| Facility | | $194.98 | $213.80 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $151.36 / $213.80
| Professional | | $89.13 | $151.36 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.14 / $100.00 / $245.47
| Facility | | $0.14 | $100.00 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $128.82 / $181.97
| Professional | | $81.28 | $128.82 | $181.97 |