- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $99.71 / $99.71 / $99.71
| Facility | | $99.71 | $99.71 | $99.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.71 / $99.71 / $161.86
| Professional | | $99.71 | $99.71 | $161.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.13 / $404.32 / $1,145.36
| Facility | | $128.13 | $404.32 | $1,145.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.11 / $152.47 / $222.85
| Professional | | $99.11 | $152.47 | $222.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $279.75 / $340.35 / $436.35
| Facility | | $279.75 | $340.35 | $436.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.43 / $202.48 / $202.48
| Professional | | $149.43 | $202.48 | $202.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.98 / $131.99 / $159.97
| Facility | | $126.98 | $131.99 | $159.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.70 / $92.70 / $274.50
| Professional | | $92.70 | $92.70 | $274.50 |
- 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
- $184.76 / $184.76 / $194.00
| Professional | | $184.76 | $184.76 | $194.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.33 / $122.33 / $122.33
| Professional | | $122.33 | $122.33 | $122.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $480.46 / $1,145.36 / $1,145.36
| Facility | | $480.46 | $1,145.36 | $1,145.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.14 / $121.98 / $222.85
| Professional | | $89.14 | $121.98 | $222.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.51 / $120.51 / $120.51
| Facility | | $120.51 | $120.51 | $120.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.06 / $121.98 / $256.73
| Professional | | $96.06 | $121.98 | $256.73 |