- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.95 / $424.79 / $440.52
| Facility | | $263.95 | $424.79 | $440.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.91 / $415.00 / $440.52
| Professional | | $345.91 | $415.00 | $440.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $514.48 / $826.47 / $868.62
| Facility | | $514.48 | $826.47 | $868.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $386.57 / $420.61 / $437.46
| Professional | | $386.57 | $420.61 | $437.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $619.85 / $1,109.83 / $1,268.38
| Facility | | $619.85 | $1,109.83 | $1,268.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $785.15 / $991.76 / $1,363.68
| Professional | | $785.15 | $991.76 | $1,363.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.80 / $512.80 / $968.52
| Facility | | $512.80 | $512.80 | $968.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.35 / $512.80 / $3,882.51
| Professional | | $374.35 | $512.80 | $3,882.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.37 / $384.76 / $462.46
| Professional | | $303.37 | $384.76 | $462.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.88 / $388.19 / $544.86
| Professional | | $274.88 | $388.19 | $544.86 |