- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $450.30 / $450.30 / $450.30
| Facility | | $450.30 | $450.30 | $450.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.94 / $352.74 / $450.30
| Professional | | $288.94 | $352.74 | $450.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.80 / $131.80 / $1,552.60
| Professional | | $131.80 | $131.80 | $1,552.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $570.94 / $570.94 / $570.94
| Facility | | $570.94 | $570.94 | $570.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,032.68 / $1,206.77 / $1,851.22
| Facility | | $1,032.68 | $1,206.77 | $1,851.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $444.11 / $1,010.47 / $1,148.26
| Professional | | $444.11 | $1,010.47 | $1,148.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.94 / $450.30 / $1,313.38
| Facility | | $288.94 | $450.30 | $1,313.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.94 / $450.30 / $1,313.38
| Facility | | $288.94 | $450.30 | $1,313.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.63 / $225.15 / $1,157.21
| Professional | | $187.63 | $225.15 | $1,157.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $70.00 / $1,035.69
| Professional | | $50.00 | $70.00 | $1,035.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.94 / $450.30 / $1,313.38
| Facility | | $288.94 | $450.30 | $1,313.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $626.40 / $894.71 / $1,254.89
| Professional | | $626.40 | $894.71 | $1,254.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.50 / $1,782.44 / $1,782.44
| Facility | | $750.50 | $1,782.44 | $1,782.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,501.00 / $1,501.00 / $1,868.75
| Professional | | $1,501.00 | $1,501.00 | $1,868.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $799.11 / $799.11 / $799.11
| Professional | | $799.11 | $799.11 | $799.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,090.56 / $2,048.87 / $2,048.87
| Professional | | $1,090.56 | $2,048.87 | $2,048.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.12 / $225.15 / $698.49
| Professional | | $163.12 | $225.15 | $698.49 |