- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.73 / $302.73 / $302.73
| Facility | | $302.73 | $302.73 | $302.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.73 / $302.73 / $456.74
| Professional | | $302.73 | $302.73 | $456.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.07 / $1,127.93 / $3,114.29
| Facility | | $363.07 | $1,127.93 | $3,114.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.95 / $462.95 / $676.63
| Professional | | $291.95 | $462.95 | $676.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.76 / $400.76 / $1,190.26
| Facility | | $400.76 | $400.76 | $1,190.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $499.06 / $614.77 / $614.77
| Professional | | $499.06 | $614.77 | $614.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.76 / $493.58 / $493.58
| Facility | | $400.76 | $493.58 | $493.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.31 / $493.58 / $884.63
| Professional | | $360.31 | $493.58 | $884.63 |
- 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
- $560.98 / $560.98 / $589.03
| Professional | | $560.98 | $560.98 | $589.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $518.27 / $518.27 / $518.27
| Professional | | $518.27 | $518.27 | $518.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.91 / $3,114.29 / $3,114.29
| Facility | | $1,548.91 | $3,114.29 | $3,114.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.64 / $370.36 / $676.63
| Professional | | $270.64 | $370.36 | $676.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $763.01 / $763.01 / $763.01
| Facility | | $763.01 | $763.01 | $763.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.49 / $370.36 / $615.89
| Professional | | $285.49 | $370.36 | $615.89 |