- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $461.62 / $1,660.74 / $6,268.79
| Facility | | $461.62 | $1,660.74 | $6,268.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.62 / $461.62 / $869.32
| Professional | | $461.62 | $461.62 | $869.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $383.15 / $450.76 / $8,639.91
| Facility | | $383.15 | $450.76 | $8,639.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.76 / $450.76 / $450.76
| Professional | | $450.76 | $450.76 | $450.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $506.88 / $506.88 / $506.88
| Facility | | $506.88 | $506.88 | $506.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.88 / $506.88 / $506.88
| Professional | | $506.88 | $506.88 | $506.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $652.66 / $652.66 / $652.66
| Facility | | $652.66 | $652.66 | $652.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $461.62 / $586.26 / $6,703.28
| Facility | | $461.62 | $586.26 | $6,703.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.62 / $461.62 / $869.32
| Professional | | $461.62 | $461.62 | $869.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $506.88 / $506.88 / $506.88
| Facility | | $506.88 | $506.88 | $506.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.88 / $506.88 / $506.88
| Professional | | $506.88 | $506.88 | $506.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $320.86 / $320.86 / $372.32
| Facility | | $320.86 | $320.86 | $372.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.86 / $320.86 / $372.32
| Professional | | $320.86 | $320.86 | $372.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $452.57 / $543.08 / $651.70
| Professional | | $452.57 | $543.08 | $651.70 |