- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $338.84 / $338.84
| Facility | | $338.84 | $338.84 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $436.52 / $831.76
| Professional | | $338.84 | $436.52 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $794.33 / $4,466.84
| Facility | | $691.83 | $794.33 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $588.84 / $794.33
| Professional | | $363.08 | $588.84 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $446.68 / $1,348.96
| Facility | | $446.68 | $446.68 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $676.08 / $676.08
| Professional | | $501.19 | $676.08 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $575.44 / $4,466.84
| Facility | | $562.34 | $575.44 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $588.84
| Professional | | $416.87 | $416.87 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $676.08 / $1,023.29
| Professional | | $676.08 | $676.08 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $489.78 / $489.78
| Professional | | $489.78 | $489.78 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $794.33 / $4,466.84
| Facility | | $691.83 | $794.33 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $588.84 / $1,047.13
| Professional | | $371.54 | $588.84 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.62 / $575.44 / $1,047.13
| Facility | | $0.62 | $575.44 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $549.54 / $676.08
| Professional | | $331.13 | $549.54 | $676.08 |