- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $429.71 / $611.41 / $823.90
| Facility | | $429.71 | $611.41 | $823.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $611.41 / $611.41
| Professional | | $575.44 | $611.41 | $611.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.84 / $683.34 / $8,459.92
| Facility | | $580.84 | $683.34 | $8,459.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $683.34 / $683.34 / $683.34
| Professional | | $683.34 | $683.34 | $683.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $611.41 / $611.41 / $611.41
| Facility | | $611.41 | $611.41 | $611.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $611.41 / $611.41 / $611.41
| Professional | | $611.41 | $611.41 | $611.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.54 / $151.54 / $263.94
| Professional | | $151.54 | $151.54 | $263.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $411.60 / $751.11 / $788.66
| Facility | | $411.60 | $751.11 | $788.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $332.38 / $611.41 / $874.32
| Facility | | $332.38 | $611.41 | $874.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $611.41 / $776.49
| Professional | | $575.44 | $611.41 | $776.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $611.41 / $611.41 / $611.41
| Facility | | $611.41 | $611.41 | $611.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $611.41 / $611.41 / $611.41
| Professional | | $611.41 | $611.41 | $611.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $683.33 / $683.33 / $751.66
| Facility | | $683.33 | $683.33 | $751.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $683.33 / $683.33 / $751.66
| Professional | | $683.33 | $683.33 | $751.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $683.34 / $683.34 / $943.69
| Professional | | $683.34 | $683.34 | $943.69 |