- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $124.34 / $124.34 / $124.34
| Facility | | $124.34 | $124.34 | $124.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.45 / $124.34 / $185.01
| Professional | | $115.45 | $124.34 | $185.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.50 / $479.97 / $1,406.43
| Facility | | $157.50 | $479.97 | $1,406.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.62 / $180.24 / $277.91
| Professional | | $117.62 | $180.24 | $277.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $164.61 / $164.61 / $488.89
| Facility | | $164.61 | $164.61 | $488.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.99 / $252.50 / $252.50
| Professional | | $204.99 | $252.50 | $252.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.76 / $164.61 / $199.52
| Facility | | $138.76 | $164.61 | $199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.29 / $138.76 / $274.13
| Professional | | $101.29 | $138.76 | $274.13 |
- 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
- $230.42 / $230.42 / $241.94
| Professional | | $230.42 | $230.42 | $241.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.10 / $141.10 / $141.10
| Professional | | $141.10 | $141.10 | $141.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $479.97 / $1,406.43 / $1,406.43
| Facility | | $479.97 | $1,406.43 | $1,406.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.79 / $152.12 / $277.91
| Professional | | $110.79 | $152.12 | $277.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $296.08 / $296.08 / $296.08
| Facility | | $296.08 | $296.08 | $296.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.79 / $152.12 / $252.96
| Professional | | $110.79 | $152.12 | $252.96 |