- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $461.36 / $461.36 / $461.36
| Facility | | $461.36 | $461.36 | $461.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.36 / $461.36 / $553.63
| Professional | | $461.36 | $461.36 | $553.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,272.15 / $1,272.15 / $1,590.19
| Facility | | $1,272.15 | $1,272.15 | $1,590.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $511.01 / $516.12 / $638.77
| Professional | | $511.01 | $516.12 | $638.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.31 / $558.22 / $905.05
| Facility | | $330.31 | $558.22 | $905.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.31 / $330.31 / $3,610.00
| Professional | | $330.31 | $330.31 | $3,610.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $145.79 / $677.34 / $781.54
| Facility | | $145.79 | $677.34 | $781.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.79 / $396.37 / $601.86
| Professional | | $145.79 | $396.37 | $601.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.88 / $504.88 / $504.88
| Professional | | $504.88 | $504.88 | $504.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.36 / $461.36 / $507.50
| Professional | | $461.36 | $461.36 | $507.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.31 / $330.31 / $330.31
| Facility | | $330.31 | $330.31 | $330.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.31 / $330.31 / $330.31
| Professional | | $330.31 | $330.31 | $330.31 |