- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $208.93 / $208.93
| Facility | | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $208.93 / $446.68
| Professional | | $151.36 | $208.93 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $489.78 / $2,238.72
| Facility | | $426.58 | $489.78 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $338.84 / $489.78
| Professional | | $177.83 | $338.84 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $275.42 / $831.76
| Facility | | $275.42 | $275.42 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $363.08 / $363.08
| Professional | | $309.03 | $363.08 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $275.42 / $331.13
| Facility | | $245.47 | $275.42 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $177.83 / $251.19
| Professional | | $177.83 | $177.83 | $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
- $416.87 / $416.87 / $630.96
| Professional | | $416.87 | $416.87 | $630.96 |
- 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
- $426.58 / $489.78 / $2,238.72
| Facility | | $426.58 | $489.78 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $363.08 / $489.78
| Professional | | $177.83 | $363.08 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.28 / $199.53 / $478.63
| Facility | | $0.28 | $199.53 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $251.19 / $416.87
| Professional | | $173.78 | $251.19 | $416.87 |