- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.31 / $87.31 / $87.31
| Facility | | $87.31 | $87.31 | $87.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.31 / $95.50 / $173.32
| Professional | | $87.31 | $95.50 | $173.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $96.11 / $303.24 / $1,265.58
| Facility | | $96.11 | $303.24 | $1,265.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.53 / $153.62 / $195.15
| Professional | | $91.53 | $153.62 | $195.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.59 / $115.59 / $343.30
| Facility | | $115.59 | $115.59 | $343.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.85 / $177.30 / $177.30
| Professional | | $130.85 | $177.30 | $177.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.59 / $146.87 / $172.35
| Facility | | $115.59 | $146.87 | $172.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.82 / $172.35 / $309.00
| Professional | | $125.82 | $172.35 | $309.00 |
- 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
- $161.79 / $161.79 / $169.88
| Professional | | $161.79 | $161.79 | $169.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.63 / $135.63 / $135.63
| Professional | | $135.63 | $135.63 | $135.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.87 / $1,265.58 / $1,265.58
| Facility | | $540.87 | $1,265.58 | $1,265.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.59 / $107.88 / $195.15
| Professional | | $82.59 | $107.88 | $195.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.16 / $131.74 / $150.19
| Facility | | $0.16 | $131.74 | $150.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.01 / $106.82 / $195.15
| Professional | | $90.01 | $106.82 | $195.15 |