- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $320.75 / $327.04 / $333.33
| Facility | | $320.75 | $327.04 | $333.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.18 / $333.33 / $540.88
| Professional | | $308.18 | $333.33 | $540.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.67 / $427.67 / $427.67
| Professional | | $427.67 | $427.67 | $427.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $718.26 / $718.26 / $718.26
| Facility | | $718.26 | $718.26 | $718.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.80 / $512.80 / $512.80
| Facility | | $512.80 | $512.80 | $512.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.35 / $374.35 / $512.80
| Professional | | $374.35 | $374.35 | $512.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,712.40 / $3,769.74 / $4,548.97
| Facility | | $1,712.40 | $3,769.74 | $4,548.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,413.46 / $5,543.37 / $6,280.80
| Professional | | $5,413.46 | $5,543.37 | $6,280.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $231.33 / $496.96 / $718.26
| Facility | | $231.33 | $496.96 | $718.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.33 / $660.80 / $765.76
| Professional | | $231.33 | $660.80 | $765.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $754.17 / $754.17 / $769.25
| Professional | | $754.17 | $754.17 | $769.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $231.33 / $500.56 / $718.26
| Facility | | $231.33 | $500.56 | $718.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.35 / $374.35 / $528.19
| Professional | | $374.35 | $374.35 | $528.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.61 / $431.82 / $514.07
| Professional | | $298.61 | $431.82 | $514.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.31 / $437.46 / $718.26
| Professional | | $430.31 | $437.46 | $718.26 |