- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $318.52 / $430.74 / $626.65
| Facility | | $318.52 | $430.74 | $626.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.52 / $318.52 / $350.38
| Professional | | $318.52 | $318.52 | $350.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $285.10 / $818.35 / $1,592.65
| Facility | | $285.10 | $818.35 | $1,592.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.52 / $318.52 / $1,374.70
| Professional | | $318.52 | $318.52 | $1,374.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $341.46 / $391.15 / $760.01
| Facility | | $341.46 | $391.15 | $760.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.36 / $318.52 / $318.52
| Facility | | $311.36 | $318.52 | $318.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.52 / $318.52 / $318.52
| Professional | | $318.52 | $318.52 | $318.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $317.42 / $501.52 / $8,090.00
| Facility | | $317.42 | $501.52 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.52 / $318.52 / $318.52
| Professional | | $318.52 | $318.52 | $318.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.52 / $318.52 / $368.67
| Professional | | $318.52 | $318.52 | $368.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22,275.65 / $22,275.65 / $22,275.65
| Facility | | $22,275.65 | $22,275.65 | $22,275.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $423.71 / $1,592.65 / $1,592.65
| Facility | | $423.71 | $1,592.65 | $1,592.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.52 / $337.64 / $1,374.70
| Professional | | $318.52 | $337.64 | $1,374.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.52 / $318.52 / $412.60
| Professional | | $318.52 | $318.52 | $412.60 |