- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.51 / $325.77 / $332.04
| Facility | | $319.51 | $325.77 | $332.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.50 / $332.04 / $498.06
| Professional | | $300.50 | $332.04 | $498.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.01 / $426.01 / $426.01
| Professional | | $426.01 | $426.01 | $426.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.47 / $715.47 / $715.47
| Facility | | $715.47 | $715.47 | $715.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $347.13 / $347.13 / $347.13
| Facility | | $347.13 | $347.13 | $347.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.40 / $253.40 / $347.13
| Professional | | $253.40 | $253.40 | $347.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,538.98 / $2,901.23 / $3,398.48
| Facility | | $1,538.98 | $2,901.23 | $3,398.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,865.13 / $4,981.91 / $4,981.91
| Professional | | $4,865.13 | $4,981.91 | $4,981.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $172.83 / $478.06 / $715.47
| Facility | | $172.83 | $478.06 | $715.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.83 / $605.04 / $715.47
| Professional | | $172.83 | $605.04 | $715.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $715.47 / $787.02 / $1,609.81
| Professional | | $715.47 | $787.02 | $1,609.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $172.83 / $478.06 / $715.47
| Facility | | $172.83 | $478.06 | $715.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.40 / $253.40 / $370.06
| Professional | | $253.40 | $253.40 | $370.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.09 / $322.61 / $384.06
| Professional | | $223.09 | $322.61 | $384.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.48 / $326.32 / $715.47
| Professional | | $321.48 | $326.32 | $715.47 |