- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $298.31 / $298.31 / $298.31
| Facility | | $298.31 | $298.31 | $298.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.31 / $298.31 / $483.33
| Professional | | $298.31 | $298.31 | $483.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.45 / $1,244.06 / $3,066.52
| Facility | | $400.45 | $1,244.06 | $3,066.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.52 / $456.19 / $666.75
| Professional | | $296.52 | $456.19 | $666.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $394.91 / $394.91 / $1,172.88
| Facility | | $394.91 | $394.91 | $1,172.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.07 / $605.79 / $605.79
| Professional | | $447.07 | $605.79 | $605.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $394.91 / $444.49 / $478.64
| Facility | | $394.91 | $444.49 | $478.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.48 / $444.49 / $796.50
| Professional | | $324.48 | $444.49 | $796.50 |
- 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
- $552.79 / $552.79 / $580.42
| Professional | | $552.79 | $552.79 | $580.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.30 / $365.30 / $365.30
| Professional | | $365.30 | $365.30 | $365.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,394.85 / $3,066.52 / $3,066.52
| Facility | | $1,394.85 | $3,066.52 | $3,066.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.70 / $364.95 / $666.75
| Professional | | $266.70 | $364.95 | $666.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.00 / $108.00 / $108.00
| Facility | | $108.00 | $108.00 | $108.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.70 / $364.95 / $574.98
| Professional | | $266.70 | $364.95 | $574.98 |