- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $146.88 / $146.88 / $146.88
| Facility | | $146.88 | $146.88 | $146.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.88 / $164.73 / $269.31
| Professional | | $146.88 | $164.73 | $269.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.52 / $522.26 / $1,746.86
| Facility | | $165.52 | $522.26 | $1,746.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.63 / $258.45 / $328.32
| Professional | | $157.63 | $258.45 | $328.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.47 / $194.47 / $577.58
| Facility | | $194.47 | $194.47 | $577.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.15 / $298.31 / $298.31
| Professional | | $220.15 | $298.31 | $298.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.47 / $244.07 / $244.07
| Facility | | $194.47 | $244.07 | $244.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.17 / $244.07 / $471.38
| Professional | | $178.17 | $244.07 | $471.38 |
- 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
- $272.20 / $272.20 / $285.81
| Professional | | $272.20 | $272.20 | $285.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.51 / $254.51 / $254.51
| Professional | | $254.51 | $254.51 | $254.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $825.09 / $1,746.86 / $1,746.86
| Facility | | $825.09 | $1,746.86 | $1,746.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.96 / $187.44 / $328.32
| Professional | | $138.96 | $187.44 | $328.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $448.26 / $448.26 / $448.26
| Facility | | $448.26 | $448.26 | $448.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.02 / $179.71 / $328.32
| Professional | | $146.02 | $179.71 | $328.32 |