- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.73 / $181.73 / $181.73
| Facility | | $181.73 | $181.73 | $181.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.55 / $210.81 / $487.50
| Professional | | $167.55 | $210.81 | $487.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $324.62 / $1,058.91 / $1,728.76
| Facility | | $324.62 | $1,058.91 | $1,728.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.62 / $315.64 / $406.17
| Professional | | $155.62 | $315.64 | $406.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $596.78 / $596.78 / $1,772.44
| Facility | | $596.78 | $596.78 | $1,772.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.34 / $300.49 / $478.98
| Professional | | $183.34 | $300.49 | $478.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.16 / $214.16 / $291.73
| Facility | | $214.16 | $214.16 | $291.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.34 / $214.16 / $320.76
| Professional | | $156.34 | $214.16 | $320.76 |
- 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
- $336.75 / $336.75 / $353.59
| Professional | | $336.75 | $336.75 | $353.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.96 / $210.56 / $210.56
| Facility | | $157.96 | $210.56 | $210.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.56 / $210.56 / $260.42
| Professional | | $210.56 | $210.56 | $260.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $633.24 / $1,728.76 / $1,728.76
| Facility | | $633.24 | $1,728.76 | $1,728.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.33 / $207.50 / $406.17
| Professional | | $138.33 | $207.50 | $406.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.72 / $271.72 / $324.62
| Professional | | $271.72 | $271.72 | $324.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.25 / $154.24 / $165.61
| Facility | | $0.25 | $154.24 | $165.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.33 / $207.50 / $348.45
| Professional | | $138.33 | $207.50 | $348.45 |