- 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
- $90.08 / $112.90 / $256.75
| Professional | | $90.08 | $112.90 | $256.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.85 / $460.01 / $939.42
| Facility | | $138.85 | $460.01 | $939.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.15 / $142.66 / $201.33
| Professional | | $89.15 | $142.66 | $201.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $491.09 / $491.09 / $1,458.54
| Facility | | $491.09 | $491.09 | $1,458.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.37 / $198.72 / $245.72
| Professional | | $133.37 | $198.72 | $245.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.02 / $127.07 / $127.07
| Facility | | $106.02 | $127.07 | $127.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.76 / $92.76 / $234.38
| Professional | | $92.76 | $92.76 | $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
- $99.61 / $99.61 / $99.61
| Facility | | $99.61 | $99.61 | $99.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.61 / $99.61 / $129.09
| Professional | | $99.61 | $99.61 | $129.09 |
- 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
- $70.56 / $102.85 / $201.33
| Professional | | $70.56 | $102.85 | $201.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.53 / $107.00 / $197.31
| Professional | | $80.53 | $107.00 | $197.31 |