- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $380.19 / $380.19
| Facility | | $380.19 | $380.19 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $407.38 / $602.56
| Professional | | $338.84 | $407.38 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $794.33 / $3,630.78
| Facility | | $501.19 | $794.33 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $630.96 / $794.33
| Professional | | $281.84 | $630.96 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $954.99 / $1,000.00
| Facility | | $954.99 | $954.99 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $724.44 / $724.44
| Professional | | $588.84 | $724.44 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $275.42 / $707.95
| Facility | | $275.42 | $275.42 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $275.42 / $891.25
| Professional | | $234.42 | $275.42 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $724.44 / $724.44
| Professional | | $281.84 | $724.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $501.19
| Professional | | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $794.33 / $3,630.78
| Facility | | $501.19 | $794.33 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $660.69 / $794.33
| Professional | | $281.84 | $660.69 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.44 / $218.78 / $467.74
| Facility | | $0.44 | $218.78 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $467.74 / $870.96
| Professional | | $281.84 | $467.74 | $870.96 |