- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $103.22 / $103.22 / $242.86
| Facility | | $103.22 | $103.22 | $242.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.22 / $103.22 / $103.22
| Professional | | $103.22 | $103.22 | $103.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.24 / $82.83 / $734.60
| Facility | | $53.24 | $82.83 | $734.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.25 / $101.19 / $124.53
| Professional | | $18.25 | $101.19 | $124.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.78 / $147.19 / $313.77
| Facility | | $123.78 | $147.19 | $313.77 |
- 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
- $20.07 / $20.07 / $23.62
| Professional | | $20.07 | $20.07 | $23.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.22 / $103.22 / $218.83
| Professional | | $103.22 | $103.22 | $218.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.36 / $115.36 / $734.60
| Facility | | $115.36 | $115.36 | $734.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.19 / $101.19 / $151.79
| Professional | | $101.19 | $101.19 | $151.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.19 / $101.19 / $141.66
| Professional | | $101.19 | $101.19 | $141.66 |