- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.65 / $346.65 / $346.65
| Facility | | $346.65 | $346.65 | $346.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.93 / $346.65 / $1,304.51
| Professional | | $271.93 | $346.65 | $1,304.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,634.95 / $1,634.95 / $4,869.80
| Facility | | $1,634.95 | $1,634.95 | $4,869.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.29 / $588.59 / $5,713.05
| Professional | | $341.29 | $588.59 | $5,713.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.35 / $625.34 / $847.17
| Professional | | $381.35 | $625.34 | $847.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $386.44 / $386.44 / $386.44
| Facility | | $386.44 | $386.44 | $386.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.23 / $511.15 / $921.73
| Professional | | $323.23 | $511.15 | $921.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $395.26 / $395.26 / $395.26
| Facility | | $395.26 | $395.26 | $395.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.22 / $352.27 / $603.61
| Professional | | $191.22 | $352.27 | $603.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.01 / $809.36 / $1,045.11
| Professional | | $410.01 | $809.36 | $1,045.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $525.57 / $701.68 / $2,371.50
| Professional | | $525.57 | $701.68 | $2,371.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,634.95 / $1,634.95 / $4,869.80
| Facility | | $1,634.95 | $1,634.95 | $4,869.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.11 / $535.33 / $5,713.05
| Professional | | $362.11 | $535.33 | $5,713.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.75 / $477.98 / $1,063.69
| Professional | | $350.75 | $477.98 | $1,063.69 |