- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.01 / $63.01 / $63.01
| Facility | | $63.01 | $63.01 | $63.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.01 / $63.01 / $108.63
| Professional | | $63.01 | $63.01 | $108.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $129.02 / $292.39 / $782.09
| Facility | | $129.02 | $292.39 | $782.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.63 / $109.44 / $140.83
| Professional | | $62.63 | $109.44 | $140.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.42 / $83.42 / $247.76
| Facility | | $83.42 | $83.42 | $247.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.87 / $121.21 / $121.21
| Professional | | $103.87 | $121.21 | $121.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.42 / $99.25 / $101.10
| Facility | | $83.42 | $99.25 | $101.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.45 / $72.45 / $166.88
| Professional | | $72.45 | $72.45 | $166.88 |
- 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
- $116.76 / $116.76 / $122.60
| Professional | | $116.76 | $116.76 | $122.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.11 / $100.11 / $100.11
| Professional | | $100.11 | $100.11 | $100.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $292.39 / $782.09 / $782.09
| Facility | | $292.39 | $782.09 | $782.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.33 / $77.09 / $140.83
| Professional | | $56.33 | $77.09 | $140.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.10 / $52.05 / $94.11
| Facility | | $0.10 | $52.05 | $94.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.60 / $77.09 / $140.83
| Professional | | $59.60 | $77.09 | $140.83 |