- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $289.60 / $289.60 / $289.60
| Facility | | $289.60 | $289.60 | $289.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.66 / $289.60 / $369.92
| Professional | | $182.66 | $289.60 | $369.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $215.18 / $966.90 / $2,733.00
| Facility | | $215.18 | $966.90 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.58 / $377.78 / $1,286.33
| Professional | | $195.58 | $377.78 | $1,286.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $124.96 / $147.78 / $192.49
| Facility | | $124.96 | $147.78 | $192.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65.31 / $131.69 / $49,037.00
| Facility | | $65.31 | $131.69 | $49,037.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.33 / $418.39 / $676.37
| Professional | | $216.33 | $418.39 | $676.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.07 / $86.39 / $6,679.00
| Facility | | $52.07 | $86.39 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.35 / $120.80 / $285.87
| Professional | | $38.35 | $120.80 | $285.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.83 / $421.40 / $606.26
| Professional | | $231.83 | $421.40 | $606.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,613.32 / $1,613.32 / $1,613.32
| Facility | | $1,613.32 | $1,613.32 | $1,613.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $736.00 / $1,740.08 / $2,796.00
| Facility | | $736.00 | $1,740.08 | $2,796.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.67 / $410.43 / $1,286.33
| Professional | | $224.67 | $410.43 | $1,286.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $2,733.00
| Facility | | $627.00 | $1,818.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.50 / $385.96 / $622.42
| Professional | | $223.50 | $385.96 | $622.42 |