- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.16 / $151.16 / $3,225.83
| Facility | | $151.16 | $151.16 | $3,225.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.16 / $151.16 / $207.60
| Professional | | $151.16 | $151.16 | $207.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.00 / $181.39 / $394.65
| Facility | | $1.00 | $181.39 | $394.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.26 / $150.33 / $151.60
| Professional | | $120.26 | $150.33 | $151.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $242.42 / $445.48 / $626.16
| Facility | | $242.42 | $445.48 | $626.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.94 / $187.74 / $204.88
| Professional | | $162.94 | $187.74 | $204.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $215.30 / $408.25 / $564.26
| Facility | | $215.30 | $408.25 | $564.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.33 / $161.33 / $172.24
| Professional | | $161.33 | $161.33 | $172.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.33 / $150.33 / $331.47
| Facility | | $150.33 | $150.33 | $331.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.33 / $150.33 / $344.84
| Professional | | $150.33 | $150.33 | $344.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.16 / $151.16 / $274.04
| Professional | | $151.16 | $151.16 | $274.04 |