- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $263.03 / $263.03
| Facility | | $263.03 | $263.03 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $338.84 / $707.95
| Professional | | $263.03 | $338.84 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $616.60 / $3,388.44
| Facility | | $537.03 | $616.60 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $467.74 / $616.60
| Professional | | $281.84 | $467.74 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $354.81 / $1,071.52
| Facility | | $354.81 | $354.81 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $512.86 / $512.86
| Professional | | $436.52 | $512.86 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $446.68 / $457.09
| Facility | | $354.81 | $446.68 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $338.84 / $457.09
| Professional | | $338.84 | $338.84 | $457.09 |
- 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
- $524.81 / $524.81 / $812.83
| Professional | | $524.81 | $524.81 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $812.83
| Facility | | $812.83 | $812.83 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $354.81 / $407.38
| Professional | | $354.81 | $354.81 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $616.60 / $3,388.44
| Facility | | $537.03 | $616.60 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $467.74 / $676.08
| Professional | | $295.12 | $467.74 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.48 / $457.09 / $831.76
| Facility | | $0.48 | $457.09 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $436.52 / $524.81
| Professional | | $263.03 | $436.52 | $524.81 |