- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $243.18 / $243.18 / $243.18
| Facility | | $243.18 | $243.18 | $243.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.55 / $243.18 / $313.39
| Professional | | $155.55 | $243.18 | $313.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $315.02 / $993.97 / $2,541.06
| Facility | | $315.02 | $993.97 | $2,541.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.91 / $334.70 / $543.53
| Professional | | $203.91 | $334.70 | $543.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $321.94 / $321.94 / $956.16
| Facility | | $321.94 | $321.94 | $956.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.45 / $364.45 / $404.48
| Professional | | $364.45 | $364.45 | $404.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $315.73 / $321.94 / $390.19
| Facility | | $315.73 | $321.94 | $390.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.48 / $315.73 / $559.00
| Professional | | $230.48 | $315.73 | $559.00 |
- 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
- $450.63 / $450.63 / $473.16
| Professional | | $450.63 | $450.63 | $473.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.43 / $267.43 / $267.43
| Professional | | $267.43 | $267.43 | $267.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,103.47 / $2,541.06 / $2,541.06
| Facility | | $1,103.47 | $2,541.06 | $2,541.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.11 / $277.67 / $543.53
| Professional | | $185.11 | $277.67 | $543.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $243.26 / $243.26 / $243.26
| Facility | | $243.26 | $243.26 | $243.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.09 / $277.67 / $456.91
| Professional | | $189.09 | $277.67 | $456.91 |