- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.48 / $175.48 / $175.48
| Facility | | $175.48 | $175.48 | $175.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.79 / $175.48 / $238.92
| Professional | | $161.79 | $175.48 | $238.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.61 / $737.75 / $1,907.74
| Facility | | $245.61 | $737.75 | $1,907.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.13 / $245.61 / $392.22
| Professional | | $147.13 | $245.61 | $392.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $232.31 / $232.31 / $689.96
| Facility | | $232.31 | $232.31 | $689.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.99 / $334.40 / $334.40
| Professional | | $262.99 | $334.40 | $334.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $188.22 / $232.31 / $281.57
| Facility | | $188.22 | $232.31 | $281.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.40 / $188.22 / $349.13
| Professional | | $137.40 | $188.22 | $349.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.18 / $325.18 / $341.44
| Professional | | $325.18 | $325.18 | $341.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.38 / $191.38 / $191.38
| Professional | | $191.38 | $191.38 | $191.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $711.56 / $1,907.74 / $1,907.74
| Facility | | $711.56 | $1,907.74 | $1,907.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.58 / $200.37 / $392.22
| Professional | | $133.58 | $200.37 | $392.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.62 / $204.62 / $204.62
| Facility | | $204.62 | $204.62 | $204.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.82 / $200.37 / $401.63
| Professional | | $135.82 | $200.37 | $401.63 |