- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $154.88 / $154.88
| Facility | | $154.88 | $154.88 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $173.78 / $309.03
| Professional | | $125.89 | $173.78 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $363.08 / $1,621.81
| Facility | | $323.59 | $363.08 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $269.15 / $363.08
| Professional | | $141.25 | $269.15 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $208.93 / $630.96
| Facility | | $208.93 | $208.93 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $275.42 / $275.42
| Professional | | $234.42 | $275.42 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $208.93 / $251.19
| Facility | | $190.55 | $208.93 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $138.04 / $208.93
| Professional | | $138.04 | $138.04 | $208.93 |
- 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
- $316.23 / $316.23 / $478.63
| Professional | | $316.23 | $316.23 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $218.78 / $218.78
| Professional | | $218.78 | $218.78 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $363.08 / $1,621.81
| Facility | | $323.59 | $363.08 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $275.42 / $363.08
| Professional | | $141.25 | $275.42 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.24 / $173.78 / $416.87
| Facility | | $0.24 | $173.78 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $190.55 / $316.23
| Professional | | $141.25 | $190.55 | $316.23 |