- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $275.42 / $275.42
| Facility | | $275.42 | $275.42 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $275.42 / $741.31
| Professional | | $218.78 | $275.42 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $645.65 / $3,162.28
| Facility | | $575.44 | $645.65 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $457.09 / $645.65
| Professional | | $251.19 | $457.09 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $831.76 / $1,096.48
| Facility | | $691.83 | $831.76 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $489.78 / $489.78
| Professional | | $371.54 | $489.78 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.23 / $371.54 / $446.68
| Facility | | $316.23 | $371.54 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $229.09 / $346.74
| Professional | | $229.09 | $229.09 | $346.74 |
- 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
- $562.34 / $562.34 / $851.14
| Professional | | $562.34 | $562.34 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $380.19 / $380.19
| Professional | | $380.19 | $380.19 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $645.65 / $3,162.28
| Facility | | $575.44 | $645.65 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $478.63 / $645.65
| Professional | | $251.19 | $478.63 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.40 / $331.13 / $676.08
| Facility | | $0.40 | $331.13 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $338.84 / $562.34
| Professional | | $234.42 | $338.84 | $562.34 |