- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.68 / $308.68 / $617.36
| Facility | | $308.68 | $308.68 | $617.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.68 / $321.02 / $368.16
| Professional | | $308.68 | $321.02 | $368.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $262.67 / $750.40 / $1,006.91
| Facility | | $262.67 | $750.40 | $1,006.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.43 / $308.68 / $379.87
| Professional | | $307.43 | $308.68 | $379.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.21 / $393.88 / $839.61
| Facility | | $331.21 | $393.88 | $839.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $308.68 / $308.68 / $308.68
| Facility | | $308.68 | $308.68 | $308.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.68 / $308.68 / $308.68
| Professional | | $308.68 | $308.68 | $308.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $306.80 / $484.74 / $8,090.00
| Facility | | $306.80 | $484.74 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.68 / $308.68 / $641.07
| Professional | | $308.68 | $308.68 | $641.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $410.61 / $410.61 / $1,543.40
| Facility | | $410.61 | $410.61 | $1,543.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.43 / $308.68 / $463.02
| Professional | | $307.43 | $308.68 | $463.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.43 / $308.68 / $432.16
| Professional | | $307.43 | $308.68 | $432.16 |