- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $178.16 / $178.16 / $178.16
| Facility | | $178.16 | $178.16 | $178.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.71 / $178.16 / $241.62
| Professional | | $151.71 | $178.16 | $241.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.61 / $630.72 / $1,631.04
| Facility | | $245.61 | $630.72 | $1,631.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.28 / $248.22 / $398.20
| Professional | | $159.28 | $248.22 | $398.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $235.86 / $235.86 / $700.50
| Facility | | $235.86 | $235.86 | $700.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.01 / $361.80 / $361.80
| Professional | | $267.01 | $361.80 | $361.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $197.02 / $235.86 / $285.87
| Facility | | $197.02 | $235.86 | $285.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.82 / $197.02 / $360.38
| Professional | | $143.82 | $197.02 | $360.38 |
- 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
- $330.15 / $330.15 / $346.66
| Professional | | $330.15 | $330.15 | $346.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.31 / $194.31 / $194.31
| Professional | | $194.31 | $194.31 | $194.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.72 / $1,631.04 / $1,631.04
| Facility | | $630.72 | $1,631.04 | $1,631.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.57 / $217.97 / $398.20
| Professional | | $152.57 | $217.97 | $398.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $136.63 / $136.63 / $136.63
| Facility | | $136.63 | $136.63 | $136.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.24 / $217.97 / $407.76
| Professional | | $155.24 | $217.97 | $407.76 |