- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.95 / $195.83 / $588.30
| Facility | | $60.95 | $195.83 | $588.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.40 / $200.56 / $558.40
| Professional | | $158.40 | $200.56 | $558.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $195.83 / $230.39 / $8,639.91
| Facility | | $195.83 | $230.39 | $8,639.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.87 / $218.87 / $218.87
| Professional | | $218.87 | $218.87 | $218.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $215.17 / $215.17 / $215.17
| Facility | | $215.17 | $215.17 | $215.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.17 / $215.17 / $215.17
| Professional | | $215.17 | $215.17 | $215.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $84.38 / $179.84 / $250.50
| Facility | | $84.38 | $179.84 | $250.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $88.18 / $186.53 / $588.30
| Facility | | $88.18 | $186.53 | $588.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.00 / $205.00 / $576.00
| Professional | | $155.00 | $205.00 | $576.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $903.90 / $946.73 / $1,387.18
| Facility | | $903.90 | $946.73 | $1,387.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $215.17 / $215.17 / $215.17
| Facility | | $215.17 | $215.17 | $215.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.17 / $215.17 / $215.17
| Professional | | $215.17 | $215.17 | $215.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $163.06 / $163.06 / $163.06
| Facility | | $163.06 | $163.06 | $163.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.06 / $163.06 / $163.06
| Professional | | $163.06 | $163.06 | $163.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.12 / $230.39 / $287.99
| Professional | | $192.12 | $230.39 | $287.99 |