- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $121.60 / $132.46 / $132.46
| Facility | | $121.60 | $132.46 | $132.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.60 / $132.46 / $4,815.52
| Professional | | $112.60 | $132.46 | $4,815.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $8,639.91 / $79,506.39
| Facility | | $5,000.00 | $8,639.91 | $79,506.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.30 / $459.41 / $459.41
| Professional | | $340.30 | $459.41 | $459.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $482.61 / $482.61 / $482.61
| Facility | | $482.61 | $482.61 | $482.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.22 / $410.22 / $482.61
| Professional | | $410.22 | $410.22 | $482.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.57 / $361.57 / $361.57
| Professional | | $361.57 | $361.57 | $361.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.46 / $132.46 / $132.46
| Facility | | $132.46 | $132.46 | $132.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.60 / $126.11 / $4,815.52
| Professional | | $112.60 | $126.11 | $4,815.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.70 / $232.40 / $771.70
| Professional | | $193.70 | $232.40 | $771.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $482.61 / $482.61 / $482.61
| Facility | | $482.61 | $482.61 | $482.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.22 / $410.22 / $482.61
| Professional | | $410.22 | $410.22 | $482.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $388.58 / $388.58 / $388.58
| Facility | | $388.58 | $388.58 | $388.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $388.58 / $388.58 / $388.58
| Professional | | $388.58 | $388.58 | $388.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.41 / $234.34 / $385.24
| Professional | | $138.41 | $234.34 | $385.24 |