- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $165.96 / $165.96
| Facility | | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $213.80 / $478.63
| Professional | | $165.96 | $213.80 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $389.05 / $2,454.71
| Facility | | $346.74 | $389.05 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $295.12 / $389.05
| Professional | | $181.97 | $295.12 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $223.87 / $676.08
| Facility | | $223.87 | $223.87 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $338.84 / $338.84
| Professional | | $251.19 | $338.84 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $281.84 / $302.00
| Facility | | $223.87 | $281.84 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $223.87 / $302.00
| Professional | | $223.87 | $223.87 | $302.00 |
- 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
- $338.84 / $338.84 / $512.86
| Professional | | $338.84 | $338.84 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $263.03 / $263.03
| Professional | | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $389.05 / $2,454.71
| Facility | | $346.74 | $389.05 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $295.12 / $426.58
| Professional | | $181.97 | $295.12 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.31 / $288.40 / $524.81
| Facility | | $0.31 | $288.40 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $275.42 / $338.84
| Professional | | $165.96 | $275.42 | $338.84 |