- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $630.96 / $630.96
| Facility | | $630.96 | $630.96 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $575.44 / $954.99
| Professional | | $457.09 | $575.44 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $724.44 / $724.44
| Facility | | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $537.03 / $537.03
| Professional | | $537.03 | $537.03 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $2,089.30 / $2,570.40
| Professional | | $794.33 | $2,089.30 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $794.33 / $1,096.48
| Facility | | $630.96 | $794.33 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $831.76 / $1,122.02
| Professional | | $776.25 | $831.76 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $1,023.29 / $1,096.48
| Facility | | $831.76 | $1,023.29 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,047.13 / $1,096.48
| Professional | | $954.99 | $1,047.13 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $870.96 / $1,318.26
| Facility | | $562.34 | $870.96 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $912.01 / $1,122.02
| Professional | | $87.10 | $912.01 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,479.11 / $3,981.07
| Facility | | $870.96 | $1,479.11 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,174.90 / $1,174.90
| Professional | | $1,071.52 | $1,174.90 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $1,584.89 / $2,089.30
| Facility | | $478.63 | $1,584.89 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $478.63 / $912.01
| Professional | | $436.52 | $478.63 | $912.01 |