- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.16 / $308.97 / $401.40
| Facility | | $131.16 | $308.97 | $401.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.16 / $133.36 / $2,056.54
| Professional | | $131.16 | $133.36 | $2,056.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.95 / $142.29 / $8,639.91
| Facility | | $120.95 | $142.29 | $8,639.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.11 / $136.11 / $136.11
| Professional | | $136.11 | $136.11 | $136.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.73 / $131.16 / $131.16
| Facility | | $123.73 | $131.16 | $131.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.16 / $131.16 / $131.16
| Professional | | $131.16 | $131.16 | $131.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.00 / $192.32 / $342.02
| Facility | | $158.00 | $192.32 | $342.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $133.36 / $327.45 / $401.40
| Facility | | $133.36 | $327.45 | $401.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.16 / $143.47 / $1,556.00
| Professional | | $131.16 | $143.47 | $1,556.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.73 / $131.16 / $131.16
| Facility | | $123.73 | $131.16 | $131.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.16 / $131.16 / $131.16
| Professional | | $131.16 | $131.16 | $131.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $146.65 / $146.65 / $170.17
| Facility | | $146.65 | $146.65 | $170.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.65 / $146.65 / $170.17
| Professional | | $146.65 | $146.65 | $170.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.16 / $141.65 / $226.05
| Professional | | $131.16 | $141.65 | $226.05 |