- 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
- $114.82 / $151.36 / $363.08
| Professional | | $114.82 | $151.36 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $354.81 / $1,778.28
| Facility | | $309.03 | $354.81 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $245.47 / $354.81
| Professional | | $131.83 | $245.47 | $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
- $229.09 / $288.40 / $288.40
| Professional | | $229.09 | $288.40 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $199.53 / $239.88
| Facility | | $173.78 | $199.53 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $125.89 / $186.21
| Professional | | $125.89 | $125.89 | $186.21 |
- 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
- $177.83 / $177.83 / $177.83
| Professional | | $177.83 | $177.83 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $354.81 / $1,778.28
| Facility | | $309.03 | $354.81 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $263.03 / $354.81
| Professional | | $131.83 | $263.03 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.22 / $177.83 / $380.19
| Facility | | $0.22 | $177.83 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $186.21 / $302.00
| Professional | | $131.83 | $186.21 | $302.00 |