- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $446.68 / $446.68
| Facility | | $446.68 | $446.68 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $446.68 / $1,148.15
| Professional | | $331.13 | $446.68 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,047.13 / $4,897.79
| Facility | | $912.01 | $1,047.13 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $741.31 / $1,047.13
| Professional | | $380.19 | $741.31 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $588.84 / $1,778.28
| Facility | | $588.84 | $588.84 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $794.33 / $794.33
| Professional | | $676.08 | $794.33 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $588.84 / $707.95
| Facility | | $549.54 | $588.84 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $575.44
| Professional | | $398.11 | $398.11 | $575.44 |
- 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
- $891.25 / $891.25 / $1,348.96
| Professional | | $891.25 | $891.25 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $489.78 / $489.78
| Professional | | $489.78 | $489.78 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,047.13 / $4,897.79
| Facility | | $912.01 | $1,047.13 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $776.25 / $1,047.13
| Professional | | $380.19 | $776.25 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.62 / $501.19 / $1,047.13
| Facility | | $0.62 | $501.19 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $549.54 / $891.25
| Professional | | $371.54 | $549.54 | $891.25 |