- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $216.29 / $216.29 / $216.29
| Facility | | $216.29 | $216.29 | $216.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.29 / $227.37 / $294.52
| Professional | | $216.29 | $227.37 | $294.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $240.27 / $941.10 / $2,801.65
| Facility | | $240.27 | $941.10 | $2,801.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.39 / $350.02 / $483.42
| Professional | | $200.39 | $350.02 | $483.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $286.33 / $286.33 / $850.43
| Facility | | $286.33 | $286.33 | $850.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.14 / $412.15 / $412.15
| Professional | | $324.14 | $412.15 | $412.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $286.33 / $345.03 / $347.04
| Facility | | $286.33 | $345.03 | $347.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.87 / $345.03 / $513.00
| Professional | | $251.87 | $345.03 | $513.00 |
- 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
- $400.81 / $400.81 / $420.85
| Professional | | $400.81 | $400.81 | $420.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.05 / $281.05 / $281.05
| Facility | | $281.05 | $281.05 | $281.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.05 / $281.05 / $288.83
| Professional | | $281.05 | $281.05 | $288.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,152.33 / $2,801.65 / $2,801.65
| Facility | | $1,152.33 | $2,801.65 | $2,801.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.91 / $246.97 / $483.42
| Professional | | $183.91 | $246.97 | $483.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.04 / $262.52 / $557.48
| Professional | | $187.04 | $262.52 | $557.48 |