- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $264.97 / $264.97 / $264.97
| Facility | | $264.97 | $264.97 | $264.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.97 / $294.75 / $494.44
| Professional | | $264.97 | $294.75 | $494.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $315.02 / $978.67 / $3,426.22
| Facility | | $315.02 | $978.67 | $3,426.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.11 / $466.21 / $592.22
| Professional | | $296.11 | $466.21 | $592.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.77 / $350.77 / $1,041.79
| Facility | | $350.77 | $350.77 | $1,041.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.81 / $509.76 / $509.76
| Professional | | $436.81 | $509.76 | $509.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.77 / $445.72 / $459.90
| Facility | | $350.77 | $445.72 | $459.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.73 / $335.73 / $802.13
| Professional | | $335.73 | $335.73 | $802.13 |
- 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
- $491.01 / $491.01 / $515.55
| Professional | | $491.01 | $491.01 | $515.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $807.10 / $807.10 / $807.10
| Facility | | $807.10 | $807.10 | $807.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.83 / $403.55 / $403.55
| Professional | | $353.83 | $403.55 | $403.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,404.50 / $3,426.22 / $3,426.22
| Facility | | $1,404.50 | $3,426.22 | $3,426.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.66 / $327.39 / $592.22
| Professional | | $250.66 | $327.39 | $592.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.38 / $324.16 / $592.22
| Professional | | $263.38 | $324.16 | $592.22 |