- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.83 / $302.83 / $302.83
| Facility | | $302.83 | $302.83 | $302.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.16 / $302.83 / $390.27
| Professional | | $293.16 | $302.83 | $390.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $507.23 / $1,157.86 / $2,777.77
| Facility | | $507.23 | $1,157.86 | $2,777.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.93 / $483.08 / $676.88
| Professional | | $253.93 | $483.08 | $676.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.92 / $400.92 / $1,190.73
| Facility | | $400.92 | $400.92 | $1,190.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $499.26 / $534.34 / $534.34
| Professional | | $499.26 | $534.34 | $534.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $379.04 / $400.92 / $485.91
| Facility | | $379.04 | $400.92 | $485.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.70 / $276.70 / $661.13
| Professional | | $276.70 | $276.70 | $661.13 |
- 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
- $561.19 / $561.19 / $589.25
| Professional | | $561.19 | $561.19 | $589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.28 / $330.28 / $330.28
| Professional | | $330.28 | $330.28 | $330.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,157.86 / $2,777.77 / $2,777.77
| Facility | | $1,157.86 | $2,777.77 | $2,777.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.53 / $345.79 / $676.88
| Professional | | $230.53 | $345.79 | $676.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $259.82 / $259.82 / $259.82
| Facility | | $259.82 | $259.82 | $259.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.48 / $345.79 / $607.39
| Professional | | $235.48 | $345.79 | $607.39 |