- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $340.43 / $340.43 / $340.43
| Facility | | $340.43 | $340.43 | $340.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.26 / $340.43 / $456.08
| Professional | | $335.26 | $340.43 | $456.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $507.23 / $1,439.32 / $3,700.92
| Facility | | $507.23 | $1,439.32 | $3,700.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.88 / $507.23 / $760.87
| Professional | | $321.88 | $507.23 | $760.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $450.67 / $450.67 / $1,338.49
| Facility | | $450.67 | $450.67 | $1,338.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.21 / $691.32 / $691.32
| Professional | | $561.21 | $691.32 | $691.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $450.67 / $483.85 / $546.22
| Facility | | $450.67 | $483.85 | $546.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.21 / $483.85 / $796.13
| Professional | | $353.21 | $483.85 | $796.13 |
- 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
- $630.84 / $630.84 / $662.38
| Professional | | $630.84 | $630.84 | $662.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.25 / $371.25 / $371.25
| Professional | | $371.25 | $371.25 | $371.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,439.32 / $3,700.92 / $3,700.92
| Facility | | $1,439.32 | $3,700.92 | $3,700.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.52 / $416.48 / $760.87
| Professional | | $291.52 | $416.48 | $760.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.42 / $389.42 / $389.42
| Facility | | $389.42 | $389.42 | $389.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.64 / $416.48 / $692.57
| Professional | | $296.64 | $416.48 | $692.57 |