- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $147.91 / $147.91
| Facility | | $147.91 | $147.91 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $147.91 / $501.19
| Professional | | $138.04 | $147.91 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $354.81 / $467.74
| Facility | | $141.25 | $354.81 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $147.91 / $186.21
| Professional | | $141.25 | $147.91 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $177.83 / $346.74
| Facility | | $177.83 | $177.83 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $165.96 / $165.96
| Facility | | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $165.96 / $165.96
| Professional | | $165.96 | $165.96 | $165.96 |
- 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
- $89.13 / $89.13 / $107.15
| Professional | | $89.13 | $89.13 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $158.49 / $263.03
| Professional | | $134.90 | $158.49 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $0.02 / $0.02
| Facility | | $0.02 | $0.02 | $0.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $354.81 / $467.74
| Facility | | $141.25 | $354.81 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $147.91 / $186.21
| Professional | | $141.25 | $147.91 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $194.98 / $251.19
| Facility | | $177.83 | $194.98 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $177.83 / $218.78
| Professional | | $147.91 | $177.83 | $218.78 |