- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $318.95 / $1,294.83 / $1,569.41
| Facility | | $318.95 | $1,294.83 | $1,569.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.15 / $303.95 / $318.95
| Professional | | $225.15 | $303.95 | $318.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.70 / $292.70 / $292.70
| Professional | | $292.70 | $292.70 | $292.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $356.11 / $514.16 / $1,245.25
| Facility | | $356.11 | $514.16 | $1,245.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,808.71 / $1,808.71 / $1,808.71
| Professional | | $1,808.71 | $1,808.71 | $1,808.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $394.01 / $506.59 / $926.87
| Professional | | $394.01 | $506.59 | $926.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $386.51 / $1,065.33 / $1,549.78
| Facility | | $386.51 | $1,065.33 | $1,549.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.28 / $318.95 / $1,549.78
| Professional | | $246.28 | $318.95 | $1,549.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $555.37 / $562.88 / $750.50
| Professional | | $555.37 | $562.88 | $750.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $365.22 / $580.80 / $1,245.25
| Facility | | $365.22 | $580.80 | $1,245.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,808.71 / $1,808.71 / $1,808.71
| Professional | | $1,808.71 | $1,808.71 | $1,808.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.25 / $375.25 / $412.78
| Facility | | $375.25 | $375.25 | $412.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.25 / $375.25 / $412.78
| Professional | | $375.25 | $375.25 | $412.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.61 / $225.15 / $501.03
| Professional | | $157.61 | $225.15 | $501.03 |