- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.93 / $245.93 / $245.93
| Facility | | $245.93 | $245.93 | $245.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.93 / $270.68 / $365.33
| Professional | | $245.93 | $270.68 | $365.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $320.36 / $1,010.80 / $3,230.86
| Facility | | $320.36 | $1,010.80 | $3,230.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.09 / $402.85 / $549.66
| Professional | | $231.09 | $402.85 | $549.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $325.57 / $325.57 / $966.94
| Facility | | $325.57 | $325.57 | $966.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.57 / $468.63 / $468.63
| Professional | | $368.57 | $468.63 | $468.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $325.57 / $361.45 / $394.60
| Facility | | $325.57 | $361.45 | $394.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.86 / $361.45 / $788.63
| Professional | | $263.86 | $361.45 | $788.63 |
- 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
- $455.72 / $455.72 / $478.51
| Professional | | $455.72 | $455.72 | $478.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $260.66 / $260.66 / $260.66
| Facility | | $260.66 | $260.66 | $260.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.46 / $347.46 / $347.46
| Professional | | $347.46 | $347.46 | $347.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.77 / $3,230.86 / $3,230.86
| Facility | | $1,380.77 | $3,230.86 | $3,230.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.08 / $280.80 / $549.66
| Professional | | $212.08 | $280.80 | $549.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $503.60 / $503.60 / $511.22
| Professional | | $503.60 | $503.60 | $511.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.70 / $280.80 / $549.66
| Professional | | $215.70 | $280.80 | $549.66 |