- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.31 / $143.31 / $337.20
| Facility | | $143.31 | $143.31 | $337.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.31 / $143.31 / $143.31
| Professional | | $143.31 | $143.31 | $143.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $103.35 / $103.35 / $818.35
| Facility | | $103.35 | $103.35 | $818.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.50 / $140.50 / $210.75
| Professional | | $140.50 | $140.50 | $210.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $171.86 / $204.38 / $435.66
| Facility | | $171.86 | $204.38 | $435.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.31 / $143.31 / $143.31
| Facility | | $143.31 | $143.31 | $143.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.31 / $143.31 / $143.31
| Professional | | $143.31 | $143.31 | $143.31 |
- 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
- $143.31 / $143.31 / $297.63
| Professional | | $143.31 | $143.31 | $297.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $168.60 / $168.60 / $516.75
| Facility | | $168.60 | $168.60 | $516.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.50 / $140.50 / $210.75
| Professional | | $140.50 | $140.50 | $210.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.50 / $140.50 / $196.71
| Professional | | $140.50 | $140.50 | $196.71 |