- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $212.97 / $212.97 / $212.97
| Facility | | $212.97 | $212.97 | $212.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.78 / $212.97 / $377.33
| Professional | | $210.78 | $212.97 | $377.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $261.63 / $825.50 / $2,733.96
| Facility | | $261.63 | $825.50 | $2,733.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.36 / $341.56 / $475.98
| Professional | | $215.36 | $341.56 | $475.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.93 / $281.93 / $837.33
| Facility | | $281.93 | $281.93 | $837.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.10 / $432.48 / $432.48
| Professional | | $351.10 | $432.48 | $432.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $279.26 / $281.93 / $341.73
| Facility | | $279.26 | $281.93 | $341.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.86 / $279.26 / $500.63
| Professional | | $203.86 | $279.26 | $500.63 |
- 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
- $394.64 / $394.64 / $414.37
| Professional | | $394.64 | $394.64 | $414.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.17 / $285.17 / $285.17
| Professional | | $285.17 | $285.17 | $285.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,068.08 / $2,733.96 / $2,733.96
| Facility | | $1,068.08 | $2,733.96 | $2,733.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.39 / $260.55 / $475.98
| Professional | | $190.39 | $260.55 | $475.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $287.68 / $287.68 / $287.68
| Facility | | $287.68 | $287.68 | $287.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.70 / $278.35 / $454.29
| Professional | | $211.70 | $278.35 | $454.29 |