- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $139.47 / $139.47 / $139.47
| Facility | | $139.47 | $139.47 | $139.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.47 / $139.47 / $219.39
| Professional | | $139.47 | $139.47 | $219.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $192.21 / $606.48 / $1,485.33
| Facility | | $192.21 | $606.48 | $1,485.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.63 / $211.83 / $311.73
| Professional | | $138.63 | $211.83 | $311.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $184.64 / $184.64 / $548.38
| Facility | | $184.64 | $184.64 | $548.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.02 / $283.23 / $283.23
| Professional | | $209.02 | $283.23 | $283.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $184.64 / $225.10 / $225.10
| Facility | | $184.64 | $225.10 | $225.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.32 / $225.10 / $403.50
| Professional | | $164.32 | $225.10 | $403.50 |
- 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
- $258.45 / $258.45 / $271.37
| Professional | | $258.45 | $258.45 | $271.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.80 / $165.80 / $165.80
| Professional | | $165.80 | $165.80 | $165.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $706.40 / $1,485.33 / $1,485.33
| Facility | | $706.40 | $1,485.33 | $1,485.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.69 / $170.63 / $311.73
| Professional | | $124.69 | $170.63 | $311.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.21 / $108.51 / $196.18
| Facility | | $0.21 | $108.51 | $196.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.21 / $170.63 / $311.73
| Professional | | $130.21 | $170.63 | $311.73 |