- 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
- $138.04 / $165.96 / $346.74
| Professional | | $138.04 | $165.96 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $354.81 / $1,737.80
| Facility | | $309.03 | $354.81 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $251.19 / $354.81
| Professional | | $154.88 | $251.19 | $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
- $251.19 / $309.03 / $309.03
| Professional | | $251.19 | $309.03 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $251.19 / $263.03
| Facility | | $199.53 | $251.19 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $194.98 / $263.03
| Professional | | $194.98 | $194.98 | $263.03 |
- 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
- $239.88 / $239.88 / $239.88
| Professional | | $239.88 | $239.88 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $354.81 / $1,737.80
| Facility | | $309.03 | $354.81 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $263.03 / $389.05
| Professional | | $154.88 | $263.03 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.25 / $229.09 / $416.87
| Facility | | $0.25 | $229.09 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $229.09 / $302.00
| Professional | | $144.54 | $229.09 | $302.00 |