- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $178.89 / $182.40 / $185.90
| Facility | | $178.89 | $182.40 | $185.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.87 / $185.90 / $411.26
| Professional | | $171.87 | $185.90 | $411.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,456.92 / $5,821.21 / $8,577.84
| Facility | | $5,456.92 | $5,821.21 | $8,577.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.64 / $190.64 / $238.52
| Professional | | $190.64 | $190.64 | $238.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.58 / $400.58 / $400.58
| Facility | | $400.58 | $400.58 | $400.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $291.02 / $291.02 / $291.02
| Facility | | $291.02 | $291.02 | $291.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.45 / $212.45 / $291.02
| Professional | | $212.45 | $212.45 | $291.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,116.90 / $2,011.56 / $2,362.69
| Facility | | $1,116.90 | $2,011.56 | $2,362.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,530.79 / $3,615.53 / $3,615.53
| Professional | | $3,530.79 | $3,615.53 | $3,615.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.15 / $277.16 / $400.58
| Facility | | $120.15 | $277.16 | $400.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.15 / $368.30 / $400.58
| Professional | | $120.15 | $368.30 | $400.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.58 / $440.64 / $901.30
| Professional | | $400.58 | $440.64 | $901.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.15 / $279.16 / $400.58
| Facility | | $120.15 | $279.16 | $400.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.45 / $212.45 / $310.19
| Professional | | $212.45 | $212.45 | $310.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $142.99 / $184.46 / $217.13
| Facility | | $142.99 | $184.46 | $217.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.10 / $224.29 / $267.01
| Professional | | $155.10 | $224.29 | $267.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.79 / $223.50 / $400.58
| Professional | | $222.79 | $223.50 | $400.58 |