- 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
- $173.78 / $229.09 / $602.56
| Professional | | $173.78 | $229.09 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $489.78 / $2,398.83
| Facility | | $371.54 | $489.78 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $338.84 / $489.78
| Professional | | $186.21 | $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
- $323.59 / $446.68 / $562.34
| Professional | | $323.59 | $446.68 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $275.42 / $331.13
| Facility | | $234.42 | $275.42 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $173.78 / $251.19
| Professional | | $173.78 | $173.78 | $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
- $257.04 / $257.04 / $288.40
| Professional | | $257.04 | $257.04 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $489.78 / $2,398.83
| Facility | | $371.54 | $489.78 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $363.08 / $489.78
| Professional | | $186.21 | $363.08 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.30 / $213.80 / $512.86
| Facility | | $0.30 | $213.80 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $257.04 / $416.87
| Professional | | $177.83 | $257.04 | $416.87 |