- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.39 / $307.39 / $307.39
| Facility | | $307.39 | $307.39 | $307.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.50 / $307.39 / $443.20
| Professional | | $303.50 | $307.39 | $443.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $427.14 / $1,261.77 / $3,116.67
| Facility | | $427.14 | $1,261.77 | $3,116.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.86 / $428.26 / $687.05
| Professional | | $284.86 | $428.26 | $687.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $406.94 / $406.94 / $1,208.60
| Facility | | $406.94 | $406.94 | $1,208.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.68 / $624.23 / $624.23
| Professional | | $460.68 | $624.23 | $624.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $402.09 / $406.94 / $493.22
| Facility | | $402.09 | $406.94 | $493.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.52 / $402.09 / $720.75
| Professional | | $293.52 | $402.09 | $720.75 |
- 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
- $569.62 / $569.62 / $598.10
| Professional | | $569.62 | $569.62 | $598.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.24 / $335.24 / $335.24
| Professional | | $335.24 | $335.24 | $335.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,261.77 / $3,116.67 / $3,116.67
| Facility | | $1,261.77 | $3,116.67 | $3,116.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.24 / $376.06 / $687.05
| Professional | | $263.24 | $376.06 | $687.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $260.00 / $260.00 / $260.00
| Facility | | $260.00 | $260.00 | $260.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.24 / $376.06 / $569.62
| Professional | | $263.24 | $376.06 | $569.62 |