- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $173.78 / $173.78
| Facility | | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $204.17 / $549.54
| Professional | | $173.78 | $204.17 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $407.38 / $2,511.89
| Facility | | $354.81 | $407.38 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $309.03 / $407.38
| Professional | | $169.82 | $309.03 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $229.09 / $707.95
| Facility | | $229.09 | $229.09 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $331.13 / $331.13
| Professional | | $263.03 | $331.13 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $251.19 / $281.84
| Facility | | $229.09 | $251.19 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $186.21 / $251.19
| Professional | | $186.21 | $186.21 | $251.19 |
- 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
- $346.74 / $346.74 / $537.03
| Professional | | $346.74 | $346.74 | $537.03 |
- 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
- $354.81 / $407.38 / $2,511.89
| Facility | | $354.81 | $407.38 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $309.03 / $407.38
| Professional | | $169.82 | $309.03 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.32 / $251.19 / $549.54
| Facility | | $0.32 | $251.19 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $239.88 / $346.74
| Professional | | $165.96 | $239.88 | $346.74 |