- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $328.34 / $328.34 / $328.34
| Facility | | $328.34 | $328.34 | $328.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.34 / $328.34 / $366.53
| Professional | | $328.34 | $328.34 | $366.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.26 / $328.34 / $367.83
| Professional | | $294.26 | $328.34 | $367.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.92 / $511.93 / $885.00
| Facility | | $302.92 | $511.93 | $885.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.92 / $337.21 / $6,027.78
| Professional | | $302.92 | $337.21 | $6,027.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.56 / $487.20 / $2,055.12
| Facility | | $346.56 | $487.20 | $2,055.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.56 / $808.58 / $2,055.12
| Professional | | $346.56 | $808.58 | $2,055.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.31 / $359.31 / $359.31
| Professional | | $359.31 | $359.31 | $359.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.34 / $348.04 / $428.74
| Professional | | $328.34 | $348.04 | $428.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.50 / $331.50 / $331.50
| Facility | | $331.50 | $331.50 | $331.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.50 / $331.50 / $331.50
| Professional | | $331.50 | $331.50 | $331.50 |