- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $363.08 / $363.08
| Facility | | $363.08 | $363.08 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $363.08 / $758.58
| Professional | | $275.42 | $363.08 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $851.14 / $3,981.07
| Facility | | $741.31 | $851.14 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $602.56 / $851.14
| Professional | | $309.03 | $602.56 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,071.52 / $1,445.44
| Facility | | $891.25 | $1,071.52 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $758.58 / $758.58
| Professional | | $602.56 | $758.58 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $524.81 / $588.84
| Facility | | $478.63 | $524.81 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $380.19 / $524.81
| Professional | | $380.19 | $380.19 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $724.44 / $1,096.48
| Professional | | $724.44 | $724.44 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $407.38 / $407.38
| Facility | | $407.38 | $407.38 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $489.78 / $549.54
| Professional | | $489.78 | $489.78 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $851.14 / $3,981.07
| Facility | | $741.31 | $851.14 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $630.96 / $851.14
| Professional | | $309.03 | $630.96 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.50 / $407.38 / $851.14
| Facility | | $0.50 | $407.38 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $446.68 / $724.44
| Professional | | $295.12 | $446.68 | $724.44 |