- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $209.74 / $209.74 / $209.74
| Facility | | $209.74 | $209.74 | $209.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.74 / $209.74 / $352.03
| Professional | | $209.74 | $209.74 | $352.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $429.50 / $1,354.64 / $2,460.44
| Facility | | $429.50 | $1,354.64 | $2,460.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.59 / $346.14 / $468.79
| Professional | | $212.59 | $346.14 | $468.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $699.94 / $699.94 / $2,078.82
| Facility | | $699.94 | $699.94 | $2,078.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.64 / $425.93 / $425.93
| Professional | | $360.64 | $425.93 | $425.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $327.20 / $327.20 / $327.20
| Facility | | $327.20 | $327.20 | $327.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.86 / $327.20 / $586.50
| Professional | | $238.86 | $327.20 | $586.50 |
- 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
- $388.66 / $388.66 / $408.09
| Professional | | $388.66 | $388.66 | $408.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.55 / $326.55 / $326.55
| Professional | | $326.55 | $326.55 | $326.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,026.75 / $2,460.44 / $2,460.44
| Facility | | $1,026.75 | $2,460.44 | $2,460.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.52 / $267.63 / $468.79
| Professional | | $187.52 | $267.63 | $468.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.33 / $276.08 / $314.79
| Facility | | $0.33 | $276.08 | $314.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $267.63 / $426.71
| Professional | | $208.93 | $267.63 | $426.71 |