- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.40 / $1,350.40 / $1,350.40
| Facility | | $1,350.40 | $1,350.40 | $1,350.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $787.48 / $1,350.40 / $1,350.40
| Professional | | $787.48 | $1,350.40 | $1,350.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $219.30 / $285.95 / $352.16
| Facility | | $219.30 | $285.95 | $352.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.47 / $1,122.47 / $1,122.47
| Facility | | $1,122.47 | $1,122.47 | $1,122.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.57 / $1,122.47 / $2,077.50
| Professional | | $341.57 | $1,122.47 | $2,077.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.88 / $1,350.40 / $1,448.01
| Facility | | $199.88 | $1,350.40 | $1,448.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,300.00 / $1,300.00 / $1,300.00
| Professional | | $1,300.00 | $1,300.00 | $1,300.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $607.13 / $821.16 / $1,320.19
| Professional | | $607.13 | $821.16 | $1,320.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,204.55 / $10,161.49 / $10,161.49
| Facility | | $2,204.55 | $10,161.49 | $10,161.49 |