- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $353.29 / $353.29 / $381.55
| Facility | | $353.29 | $353.29 | $381.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.39 / $381.55 / $706.57
| Professional | | $325.39 | $381.55 | $706.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.70 / $572.91 / $605.19
| Professional | | $448.70 | $572.91 | $605.19 |
- 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
- $384.02 / $432.42 / $480.47
| Professional | | $384.02 | $432.42 | $480.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $706.57 / $706.57 / $806.92
| Facility | | $706.57 | $706.57 | $806.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $427.25 / $427.25 / $427.25
| Facility | | $427.25 | $427.25 | $427.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.89 / $311.89 / $427.25
| Professional | | $311.89 | $311.89 | $427.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,575.73 / $3,613.43 / $4,330.34
| Facility | | $1,575.73 | $3,613.43 | $4,330.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,729.14 / $4,842.63 / $5,128.05
| Professional | | $4,729.14 | $4,842.63 | $5,128.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $220.22 / $562.36 / $806.92
| Facility | | $220.22 | $562.36 | $806.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.70 / $742.37 / $867.06
| Professional | | $222.70 | $742.37 | $867.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $220.22 / $539.17 / $806.92
| Facility | | $220.22 | $539.17 | $806.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.89 / $311.89 / $455.47
| Professional | | $311.89 | $311.89 | $455.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.26 / $420.52 / $522.00
| Professional | | $284.26 | $420.52 | $522.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $413.75 / $414.81 / $806.92
| Professional | | $413.75 | $414.81 | $806.92 |