- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $1,230.27
| Facility | | $151.36 | $151.36 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $512.86
| Professional | | $151.36 | $151.36 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.89 / $239.88 / $691.83
| Facility | | $125.89 | $239.88 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $125.89 / $380.19
| Professional | | $125.89 | $125.89 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $251.19 / $338.84
| Facility | | $218.78 | $251.19 | $338.84 |
- 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
- $151.36 / $151.36 / $151.36
| Professional | | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $234.42 / $8,511.38
| Facility | | $134.90 | $234.42 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $181.97 / $213.80
| Professional | | $181.97 | $181.97 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $158.49
| Professional | | $151.36 | $151.36 | $158.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,995.26 / $3,235.94
| Facility | | $912.01 | $1,995.26 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.89 / $239.88 / $691.83
| Facility | | $125.89 | $239.88 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $125.89 / $398.11
| Professional | | $125.89 | $125.89 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $338.84 / $380.19
| Facility | | $158.49 | $338.84 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $151.36 / $331.13
| Professional | | $125.89 | $151.36 | $331.13 |