- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $286.83 / $286.83 / $286.83
| Facility | | $286.83 | $286.83 | $286.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.83 / $286.83 / $474.06
| Professional | | $286.83 | $286.83 | $474.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.07 / $1,127.93 / $3,076.44
| Facility | | $363.07 | $1,127.93 | $3,076.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.10 / $458.52 / $641.09
| Professional | | $289.10 | $458.52 | $641.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $379.72 / $379.72 / $1,127.77
| Facility | | $379.72 | $379.72 | $1,127.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $429.87 / $582.48 / $582.48
| Professional | | $429.87 | $582.48 | $582.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $379.72 / $482.50 / $499.82
| Facility | | $379.72 | $482.50 | $499.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.87 / $499.82 / $895.88
| Professional | | $364.87 | $499.82 | $895.88 |
- 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
- $531.52 / $531.52 / $558.10
| Professional | | $531.52 | $531.52 | $558.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $388.74 / $388.74 / $388.74
| Professional | | $388.74 | $388.74 | $388.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,568.50 / $3,076.44 / $3,076.44
| Facility | | $1,568.50 | $3,076.44 | $3,076.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.44 / $350.91 / $641.09
| Professional | | $256.44 | $350.91 | $641.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.46 / $240.92 / $435.59
| Facility | | $0.46 | $240.92 | $435.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.33 / $350.91 / $598.34
| Professional | | $271.33 | $350.91 | $598.34 |