- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $418.43 / $418.43 / $451.90
| Facility | | $418.43 | $418.43 | $451.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $408.26 / $451.90 / $836.86
| Professional | | $408.26 | $451.90 | $836.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $454.84 / $569.05 / $569.05
| Professional | | $454.84 | $569.05 | $569.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $955.72 / $955.72 / $955.72
| Facility | | $955.72 | $955.72 | $955.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.94 / $612.94 / $612.94
| Facility | | $612.94 | $612.94 | $612.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.45 / $447.45 / $612.94
| Professional | | $447.45 | $447.45 | $612.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,105.06 / $4,719.35 / $5,543.92
| Facility | | $2,105.06 | $4,719.35 | $5,543.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,654.78 / $6,814.49 / $6,814.49
| Professional | | $6,654.78 | $6,814.49 | $6,814.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.93 / $666.04 / $955.72
| Facility | | $281.93 | $666.04 | $955.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.11 / $860.15 / $955.72
| Professional | | $285.11 | $860.15 | $955.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.93 / $638.58 / $955.72
| Facility | | $281.93 | $638.58 | $955.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.45 / $447.45 / $653.41
| Professional | | $447.45 | $447.45 | $653.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $329.75 / $577.08 / $672.95
| Facility | | $329.75 | $577.08 | $672.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.92 / $538.36 / $657.98
| Professional | | $363.92 | $538.36 | $657.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.69 / $532.32 / $955.72
| Professional | | $529.69 | $532.32 | $955.72 |