- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.49 / $302.49 / $302.49
| Facility | | $302.49 | $302.49 | $302.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.49 / $309.70 / $540.34
| Professional | | $302.49 | $309.70 | $540.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $373.75 / $1,161.10 / $3,692.36
| Facility | | $373.75 | $1,161.10 | $3,692.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.05 / $532.23 / $676.09
| Professional | | $338.05 | $532.23 | $676.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.45 / $400.45 / $1,189.33
| Facility | | $400.45 | $400.45 | $1,189.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $453.33 / $614.27 / $614.27
| Professional | | $453.33 | $614.27 | $614.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.45 / $432.60 / $485.35
| Facility | | $400.45 | $432.60 | $485.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.80 / $432.60 / $802.50
| Professional | | $315.80 | $432.60 | $802.50 |
- 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
- $560.54 / $560.54 / $588.57
| Professional | | $560.54 | $560.54 | $588.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $439.85 / $439.85 / $439.85
| Professional | | $439.85 | $439.85 | $439.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,405.39 / $3,692.36 / $3,692.36
| Facility | | $1,405.39 | $3,692.36 | $3,692.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $286.14 / $370.06 / $676.09
| Professional | | $286.14 | $370.06 | $676.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.55 / $287.83 / $520.39
| Facility | | $0.55 | $287.83 | $520.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.68 / $370.06 / $676.09
| Professional | | $300.68 | $370.06 | $676.09 |