- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $213.80 / $213.80
| Facility | | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $213.80 / $575.44
| Professional | | $186.21 | $213.80 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $501.19 / $2,570.40
| Facility | | $380.19 | $501.19 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $346.74 / $501.19
| Professional | | $190.55 | $346.74 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $281.84 / $851.14
| Facility | | $281.84 | $281.84 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $371.54 / $371.54
| Professional | | $316.23 | $371.54 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $281.84 / $338.84
| Facility | | $251.19 | $281.84 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $181.97 / $257.04
| Professional | | $181.97 | $181.97 | $257.04 |
- 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
- $426.58 / $426.58 / $645.65
| Professional | | $426.58 | $426.58 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $257.04 / $257.04
| Professional | | $257.04 | $257.04 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $501.19 / $2,570.40
| Facility | | $380.19 | $501.19 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $371.54 / $524.81
| Professional | | $190.55 | $371.54 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.32 / $257.04 / $549.54
| Facility | | $0.32 | $257.04 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $257.04 / $426.58
| Professional | | $190.55 | $257.04 | $426.58 |