- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $205.71 / $209.74 / $213.78
| Facility | | $205.71 | $209.74 | $213.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.51 / $213.78 / $302.51
| Professional | | $181.51 | $213.78 | $302.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.27 / $274.27 / $274.27
| Professional | | $274.27 | $274.27 | $274.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $460.64 / $460.64 / $460.64
| Facility | | $460.64 | $460.64 | $460.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $215.87 / $215.87 / $215.87
| Facility | | $215.87 | $215.87 | $215.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.59 / $157.59 / $215.87
| Professional | | $157.59 | $157.59 | $215.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.85 / $1,848.60 / $2,188.04
| Facility | | $891.85 | $1,848.60 | $2,188.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,819.48 / $2,887.16 / $2,887.16
| Professional | | $2,819.48 | $2,887.16 | $2,887.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $111.27 / $307.79 / $460.64
| Facility | | $111.27 | $307.79 | $460.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.27 / $389.54 / $460.64
| Professional | | $111.27 | $389.54 | $460.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.64 / $506.70 / $1,036.44
| Professional | | $460.64 | $506.70 | $1,036.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $111.27 / $307.79 / $460.64
| Facility | | $111.27 | $307.79 | $460.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.59 / $157.59 / $230.13
| Professional | | $157.59 | $157.59 | $230.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.63 / $207.70 / $247.27
| Professional | | $143.63 | $207.70 | $247.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.98 / $210.09 / $460.64
| Professional | | $206.98 | $210.09 | $460.64 |