- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $264.95 / $390.74 / $390.74
| Facility | | $264.95 | $390.74 | $390.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.95 / $411.37 / $799.66
| Professional | | $361.95 | $411.37 | $799.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $527.21 / $1,663.46 / $3,884.93
| Facility | | $527.21 | $1,663.46 | $3,884.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.57 / $541.94 / $873.34
| Professional | | $334.57 | $541.94 | $873.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $949.20 / $1,154.82 / $1,487.19
| Facility | | $949.20 | $1,154.82 | $1,487.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.79 / $604.76 / $604.76
| Professional | | $514.79 | $604.76 | $604.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $460.00 / $517.28 / $626.96
| Facility | | $460.00 | $517.28 | $626.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.80 / $459.38 / $853.81
| Professional | | $335.80 | $459.38 | $853.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.07 / $724.07 / $760.27
| Professional | | $724.07 | $724.07 | $760.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $435.27 / $435.27 / $491.60
| Facility | | $435.27 | $435.27 | $491.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $491.60 / $491.60 / $491.60
| Professional | | $491.60 | $491.60 | $491.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,684.72 / $3,884.93 / $3,884.93
| Facility | | $1,684.72 | $3,884.93 | $3,884.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.44 / $446.15 / $873.34
| Professional | | $297.44 | $446.15 | $873.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.26 / $478.04 / $873.34
| Professional | | $310.26 | $478.04 | $873.34 |