- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $390.44 / $390.44 / $390.44
| Facility | | $390.44 | $390.44 | $390.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $390.44 / $390.44 / $576.88
| Professional | | $390.44 | $390.44 | $576.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $533.92 / $1,636.61 / $3,451.92
| Facility | | $533.92 | $1,636.61 | $3,451.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.82 / $543.95 / $872.66
| Professional | | $361.82 | $543.95 | $872.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $516.88 / $516.88 / $1,535.13
| Facility | | $516.88 | $516.88 | $1,535.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $643.65 / $792.87 / $792.87
| Professional | | $643.65 | $792.87 | $792.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $418.79 / $516.88 / $626.46
| Facility | | $418.79 | $516.88 | $626.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.72 / $418.79 / $934.50
| Professional | | $305.72 | $418.79 | $934.50 |
- 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
- $723.51 / $723.51 / $759.69
| Professional | | $723.51 | $723.51 | $759.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.13 / $477.13 / $477.13
| Professional | | $477.13 | $477.13 | $477.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,636.61 / $3,451.92 / $3,451.92
| Facility | | $1,636.61 | $3,451.92 | $3,451.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.36 / $477.66 / $872.66
| Professional | | $334.36 | $477.66 | $872.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $306.73 / $306.73 / $306.73
| Facility | | $306.73 | $306.73 | $306.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.22 / $477.66 / $751.11
| Professional | | $340.22 | $477.66 | $751.11 |