- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $226.26 / $230.70 / $235.13
| Facility | | $226.26 | $230.70 | $235.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.95 / $235.13 / $405.44
| Professional | | $212.95 | $235.13 | $405.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.68 / $301.68 / $301.68
| Professional | | $301.68 | $301.68 | $301.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $506.66 / $506.66 / $506.66
| Facility | | $506.66 | $506.66 | $506.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $297.62 / $297.62 / $297.62
| Facility | | $297.62 | $297.62 | $297.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.26 / $217.26 / $297.62
| Professional | | $217.26 | $217.26 | $297.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,149.47 / $2,544.94 / $3,016.58
| Facility | | $1,149.47 | $2,544.94 | $3,016.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,633.98 / $3,721.19 / $3,721.19
| Professional | | $3,633.98 | $3,721.19 | $3,721.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.41 / $353.08 / $506.66
| Facility | | $153.41 | $353.08 | $506.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.41 / $455.99 / $600.79
| Professional | | $153.41 | $455.99 | $600.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.66 / $557.33 / $1,139.98
| Professional | | $506.66 | $557.33 | $1,139.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.41 / $338.52 / $506.66
| Facility | | $153.41 | $338.52 | $506.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.26 / $217.26 / $317.27
| Professional | | $217.26 | $217.26 | $317.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.02 / $286.36 / $340.90
| Professional | | $198.02 | $286.36 | $340.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.36 / $289.64 / $506.66
| Professional | | $285.36 | $289.64 | $506.66 |