- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $358.02 / $358.02 / $358.02
| Facility | | $358.02 | $358.02 | $358.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.31 / $358.02 / $516.60
| Professional | | $341.31 | $358.02 | $516.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.03 / $1,418.95 / $3,892.15
| Facility | | $630.03 | $1,418.95 | $3,892.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.25 / $600.03 / $800.20
| Professional | | $328.25 | $600.03 | $800.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $473.96 / $473.96 / $1,407.66
| Facility | | $473.96 | $473.96 | $1,407.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $590.22 / $727.04 / $727.04
| Professional | | $590.22 | $727.04 | $727.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $452.18 / $473.96 / $574.45
| Facility | | $452.18 | $473.96 | $574.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.09 / $452.18 / $810.38
| Professional | | $330.09 | $452.18 | $810.38 |
- 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
- $663.43 / $663.43 / $696.60
| Professional | | $663.43 | $663.43 | $696.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $390.44 / $390.44 / $390.44
| Professional | | $390.44 | $390.44 | $390.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,418.95 / $3,892.15 / $3,892.15
| Facility | | $1,418.95 | $3,892.15 | $3,892.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.58 / $438.01 / $800.20
| Professional | | $306.58 | $438.01 | $800.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $819.40 / $819.40 / $819.40
| Facility | | $819.40 | $819.40 | $819.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.58 / $438.01 / $728.37
| Professional | | $306.58 | $438.01 | $728.37 |