- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.25 / $308.25 / $308.25
| Facility | | $308.25 | $308.25 | $308.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.25 / $340.66 / $633.12
| Professional | | $308.25 | $340.66 | $633.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $428.47 / $1,331.12 / $4,468.09
| Facility | | $428.47 | $1,331.12 | $4,468.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.48 / $542.36 / $688.95
| Professional | | $344.48 | $542.36 | $688.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $408.07 / $408.07 / $1,211.97
| Facility | | $408.07 | $408.07 | $1,211.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $508.16 / $625.96 / $625.96
| Professional | | $508.16 | $625.96 | $625.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $408.07 / $448.56 / $494.59
| Facility | | $408.07 | $448.56 | $494.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.45 / $448.56 / $817.88
| Professional | | $327.45 | $448.56 | $817.88 |
- 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
- $571.20 / $571.20 / $599.76
| Professional | | $571.20 | $571.20 | $599.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $483.80 / $483.80 / $483.80
| Professional | | $483.80 | $483.80 | $483.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,432.14 / $4,468.09 / $4,468.09
| Facility | | $1,432.14 | $4,468.09 | $4,468.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.60 / $379.87 / $688.95
| Professional | | $291.60 | $379.87 | $688.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.15 / $470.15 / $470.15
| Facility | | $470.15 | $470.15 | $470.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.39 / $377.11 / $688.95
| Professional | | $306.39 | $377.11 | $688.95 |