- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $148.36 / $148.36 / $148.36
| Facility | | $148.36 | $148.36 | $148.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.36 / $148.36 / $227.73
| Professional | | $148.36 | $148.36 | $227.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.16 / $778.79 / $1,822.29
| Facility | | $144.16 | $778.79 | $1,822.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.63 / $227.66 / $331.60
| Professional | | $132.63 | $227.66 | $331.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $196.41 / $196.41 / $583.34
| Facility | | $196.41 | $196.41 | $583.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.34 / $261.77 / $261.77
| Professional | | $222.34 | $261.77 | $261.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $196.41 / $225.30 / $238.04
| Facility | | $196.41 | $225.30 | $238.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.47 / $225.30 / $444.75
| Professional | | $164.47 | $225.30 | $444.75 |
- 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
- $274.93 / $274.93 / $288.68
| Professional | | $274.93 | $274.93 | $288.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.18 / $196.18 / $196.18
| Professional | | $196.18 | $196.18 | $196.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $778.79 / $1,822.29 / $1,822.29
| Facility | | $778.79 | $1,822.29 | $1,822.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.62 / $169.40 / $331.60
| Professional | | $119.62 | $169.40 | $331.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $383.64 / $383.64 / $383.64
| Facility | | $383.64 | $383.64 | $383.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.34 / $169.40 / $287.73
| Professional | | $130.34 | $169.40 | $287.73 |