- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $295.12 / $295.12
| Facility | | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $302.00 / $426.58
| Professional | | $251.19 | $302.00 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $588.84 / $977.24
| Facility | | $588.84 | $588.84 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $549.54 / $660.69
| Professional | | $501.19 | $549.54 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $1,318.26 / $2,951.21
| Facility | | $323.59 | $1,318.26 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $851.14 / $1,122.02
| Professional | | $239.88 | $851.14 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $446.68 / $691.83
| Facility | | $295.12 | $446.68 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $645.65 / $707.95
| Professional | | $575.44 | $645.65 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $588.84 / $2,691.53
| Facility | | $107.15 | $588.84 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $309.03 / $660.69
| Professional | | $257.04 | $309.03 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $57.54 / $70.79
| Professional | | $47.86 | $57.54 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $891.25 / $1,621.81
| Professional | | $588.84 | $891.25 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $1,174.90 / $2,691.53
| Facility | | $107.15 | $1,174.90 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $478.63 / $2,951.21
| Professional | | $239.88 | $478.63 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.10 / $288.40 / $851.14
| Facility | | $87.10 | $288.40 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $288.40 / $489.78
| Professional | | $204.17 | $288.40 | $489.78 |