- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Facility | | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $151.36 / $251.19
| Professional | | $120.23 | $151.36 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $354.81 / $1,445.44
| Facility | | $269.15 | $354.81 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $251.19 / $354.81
| Professional | | $128.82 | $251.19 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $199.53 / $602.56
| Facility | | $199.53 | $199.53 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $251.19 / $251.19
| Professional | | $223.87 | $251.19 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $199.53 / $239.88
| Facility | | $190.55 | $199.53 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $138.04 / $199.53
| Professional | | $138.04 | $138.04 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $302.00 / $457.09
| Professional | | $302.00 | $302.00 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $173.78 / $173.78
| Professional | | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $354.81 / $1,445.44
| Facility | | $269.15 | $354.81 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $263.03 / $354.81
| Professional | | $128.82 | $263.03 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.21 / $147.91 / $354.81
| Facility | | $0.21 | $147.91 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $186.21 / $302.00
| Professional | | $123.03 | $186.21 | $302.00 |