- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $211.21 / $211.21 / $211.21
| Facility | | $211.21 | $211.21 | $211.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.94 / $211.21 / $288.27
| Professional | | $140.94 | $211.21 | $288.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $279.98 / $883.06 / $1,352.24
| Facility | | $279.98 | $883.06 | $1,352.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.18 / $301.88 / $373.19
| Professional | | $173.18 | $301.88 | $373.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $915.12 / $915.12 / $2,717.91
| Facility | | $915.12 | $915.12 | $2,717.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.52 / $375.18 / $562.57
| Professional | | $235.52 | $375.18 | $562.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $301.51 / $301.51 / $301.51
| Facility | | $301.51 | $301.51 | $301.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.10 / $301.51 / $353.25
| Professional | | $220.10 | $301.51 | $353.25 |
- 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
- $391.40 / $391.40 / $410.97
| Professional | | $391.40 | $391.40 | $410.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $232.03 / $232.03 / $232.03
| Facility | | $232.03 | $232.03 | $232.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.03 / $232.03 / $232.03
| Professional | | $232.03 | $232.03 | $232.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $596.97 / $1,352.24 / $1,352.24
| Facility | | $596.97 | $1,352.24 | $1,352.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.18 / $241.17 / $378.34
| Professional | | $173.18 | $241.17 | $378.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.18 / $242.45 / $397.17
| Professional | | $173.18 | $242.45 | $397.17 |