- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $189.64 / $189.64 / $189.64
| Facility | | $189.64 | $189.64 | $189.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.64 / $189.64 / $343.28
| Professional | | $189.64 | $189.64 | $343.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $240.27 / $758.11 / $2,414.09
| Facility | | $240.27 | $758.11 | $2,414.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.73 / $313.94 / $423.84
| Professional | | $203.73 | $313.94 | $423.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.06 / $251.06 / $745.65
| Facility | | $251.06 | $251.06 | $745.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.20 / $385.10 / $385.10
| Professional | | $284.20 | $385.10 | $385.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.06 / $299.52 / $304.27
| Facility | | $251.06 | $299.52 | $304.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.65 / $299.52 / $536.63
| Professional | | $218.65 | $299.52 | $536.63 |
- 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
- $351.41 / $351.41 / $368.98
| Professional | | $351.41 | $351.41 | $368.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.44 / $259.44 / $259.44
| Professional | | $259.44 | $259.44 | $259.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $939.89 / $2,414.09 / $2,414.09
| Facility | | $939.89 | $2,414.09 | $2,414.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.78 / $239.27 / $423.84
| Professional | | $169.78 | $239.27 | $423.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $544.49 / $544.49 / $544.49
| Facility | | $544.49 | $544.49 | $544.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.40 / $232.01 / $423.84
| Professional | | $179.40 | $232.01 | $423.84 |