- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $223.87 / $223.87
| Facility | | $223.87 | $223.87 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $251.19 / $616.60
| Professional | | $186.21 | $251.19 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $524.81 / $2,630.27
| Facility | | $457.09 | $524.81 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $371.54 / $524.81
| Professional | | $208.93 | $371.54 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $295.12 / $912.01
| Facility | | $295.12 | $295.12 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $457.09 / $457.09
| Professional | | $338.84 | $457.09 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $363.08 / $363.08
| Facility | | $295.12 | $363.08 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $263.03 / $363.08
| Professional | | $263.03 | $263.03 | $363.08 |
- 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
- $446.68 / $446.68 / $691.83
| Professional | | $446.68 | $446.68 | $691.83 |
- 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
- $457.09 / $524.81 / $2,630.27
| Facility | | $457.09 | $524.81 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $389.05 / $575.44
| Professional | | $208.93 | $389.05 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.33 / $316.23 / $575.44
| Facility | | $0.33 | $316.23 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $316.23 / $446.68
| Professional | | $208.93 | $316.23 | $446.68 |