- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $272.27 / $272.27 / $272.27
| Facility | | $272.27 | $272.27 | $272.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.03 / $272.27 / $272.27
| Professional | | $251.03 | $272.27 | $272.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $525.36 / $557.05 / $696.32
| Professional | | $525.36 | $557.05 | $696.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $261.57 / $424.24 / $767.09
| Facility | | $261.57 | $424.24 | $767.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.20 / $523.67 / $1,914.64
| Professional | | $314.20 | $523.67 | $1,914.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $556.08 / $635.25 / $831.13
| Facility | | $556.08 | $635.25 | $831.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.28 / $613.49 / $790.65
| Professional | | $489.28 | $613.49 | $790.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.11 / $450.52 / $513.64
| Professional | | $345.11 | $450.52 | $513.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $2,000.00 / $2,000.00
| Facility | | $2,000.00 | $2,000.00 | $2,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.20 / $465.80 / $724.58
| Professional | | $314.20 | $465.80 | $724.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.79 / $623.29 / $648.20
| Professional | | $529.79 | $623.29 | $648.20 |