- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $309.03 / $309.03
| Facility | | $309.03 | $309.03 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $309.03 / $512.86
| Professional | | $239.88 | $309.03 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $724.44 / $3,388.44
| Facility | | $630.96 | $724.44 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $501.19 / $724.44
| Professional | | $263.03 | $501.19 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $407.38 / $1,230.27
| Facility | | $407.38 | $407.38 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $645.65 / $645.65
| Professional | | $512.86 | $645.65 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $407.38 / $489.78
| Facility | | $331.13 | $407.38 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $239.88 / $354.81
| Professional | | $239.88 | $239.88 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $616.60 / $933.25
| Professional | | $616.60 | $616.60 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $338.84 / $338.84
| Professional | | $338.84 | $338.84 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $724.44 / $3,388.44
| Facility | | $630.96 | $724.44 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $537.03 / $724.44
| Professional | | $263.03 | $537.03 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.42 / $346.74 / $724.44
| Facility | | $0.42 | $346.74 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $380.19 / $616.60
| Professional | | $251.19 | $380.19 | $616.60 |