- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.28 / $132.28 / $132.28
| Facility | | $132.28 | $132.28 | $132.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.55 / $132.28 / $219.64
| Professional | | $101.55 | $132.28 | $219.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $262.23 / $288.45 / $477.26
| Facility | | $262.23 | $288.45 | $477.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.79 / $243.87 / $322.54
| Professional | | $226.79 | $243.87 | $322.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $188.64 / $561.16 / $561.16
| Facility | | $188.64 | $561.16 | $561.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $159.21 / $579.04 / $1,094.46
| Facility | | $159.21 | $579.04 | $1,094.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.22 / $386.24 / $496.29
| Professional | | $116.22 | $386.24 | $496.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $78.51 / $198.42 / $301.56
| Facility | | $78.51 | $198.42 | $301.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.15 / $262.23 / $314.68
| Professional | | $150.15 | $262.23 | $314.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.28 / $262.23 / $1,295.00
| Facility | | $132.28 | $262.23 | $1,295.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.61 / $175.23 / $296.07
| Professional | | $121.61 | $175.23 | $296.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $70.00 / $204.02
| Professional | | $50.00 | $70.00 | $204.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $78.51 / $198.42 / $301.56
| Facility | | $78.51 | $198.42 | $301.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.15 / $262.23 / $314.68
| Professional | | $150.15 | $262.23 | $314.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.23 / $403.55 / $729.69
| Professional | | $262.23 | $403.55 | $729.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $159.21 / $512.16 / $1,295.00
| Facility | | $159.21 | $512.16 | $1,295.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.22 / $159.21 / $1,472.02
| Professional | | $116.22 | $159.21 | $1,472.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.23 / $262.23 / $262.23
| Professional | | $262.23 | $262.23 | $262.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.23 / $262.23 / $262.23
| Professional | | $262.23 | $262.23 | $262.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.47 / $174.42 / $224.90
| Professional | | $104.47 | $174.42 | $224.90 |