- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $281.84 / $660.69
| Facility | | $104.71 | $281.84 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $104.71 / $125.89
| Professional | | $81.28 | $104.71 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $575.44
| Facility | | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $91.20 / $616.60
| Professional | | $72.44 | $91.20 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $104.71 / $104.71
| Professional | | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.50 / $109.65 / $194.98
| Facility | | $95.50 | $109.65 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $147.91 / $177.83
| Professional | | $87.10 | $147.91 | $177.83 |
- 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
- $177.83 / $177.83 / $208.93
| Professional | | $177.83 | $177.83 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $123.03 / $263.03
| Professional | | $123.03 | $123.03 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $691.83 / $691.83
| Facility | | $691.83 | $691.83 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $575.44
| Facility | | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $91.20 / $616.60
| Professional | | $72.44 | $91.20 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $123.03 / $181.97
| Facility | | $91.20 | $123.03 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $123.03 / $257.04
| Professional | | $72.44 | $123.03 | $257.04 |