- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.69 / $150.69 / $150.69
| Facility | | $150.69 | $150.69 | $150.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.69 / $150.69 / $201.89
| Professional | | $150.69 | $150.69 | $201.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $215.67 / $680.49 / $1,316.67
| Facility | | $215.67 | $680.49 | $1,316.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.65 / $215.67 / $336.82
| Professional | | $139.65 | $215.67 | $336.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.50 / $199.50 / $592.52
| Facility | | $199.50 | $199.50 | $592.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.84 / $306.02 / $306.02
| Professional | | $225.84 | $306.02 | $306.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $161.63 / $199.50 / $241.80
| Facility | | $161.63 | $199.50 | $241.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.99 / $161.63 / $399.75
| Professional | | $117.99 | $161.63 | $399.75 |
- 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
- $279.25 / $279.25 / $293.20
| Professional | | $279.25 | $279.25 | $293.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.36 / $164.36 / $164.36
| Professional | | $164.36 | $164.36 | $164.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $700.15 / $1,316.67 / $1,316.67
| Facility | | $700.15 | $1,316.67 | $1,316.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.05 / $184.36 / $336.82
| Professional | | $129.05 | $184.36 | $336.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.21 / $107.54 / $194.44
| Facility | | $0.21 | $107.54 | $194.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.31 / $184.36 / $279.25
| Professional | | $131.31 | $184.36 | $279.25 |