- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $346.74 / $346.74
| Facility | | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $309.03 / $346.74
| Professional | | $295.12 | $309.03 | $346.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.50 / $234.42 / $812.83
| Facility | | $95.50 | $234.42 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $707.95
| Professional | | $416.87 | $416.87 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $309.03 / $309.03
| Facility | | $309.03 | $309.03 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $309.03 / $309.03
| Professional | | $309.03 | $309.03 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $331.13 / $891.25
| Facility | | $309.03 | $331.13 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $309.03 / $316.23
| Professional | | $302.00 | $309.03 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $302.00
| Professional | | $30.20 | $30.20 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.74 / $95.50 / $891.25
| Facility | | $40.74 | $95.50 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $346.74 / $436.52
| Professional | | $331.13 | $346.74 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $346.74 / $616.60
| Professional | | $346.74 | $346.74 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $302.00 / $426.58
| Professional | | $302.00 | $302.00 | $426.58 |