- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $281.84 / $281.84
| Facility | | $281.84 | $281.84 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $234.42 / $309.03
| Professional | | $162.18 | $234.42 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $371.54 / $758.58
| Facility | | $309.03 | $371.54 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $288.40 / $309.03
| Professional | | $281.84 | $288.40 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $229.09 / $229.09
| Facility | | $104.71 | $229.09 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $194.98 / $426.58
| Professional | | $194.98 | $194.98 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $181.97 / $263.03
| Professional | | $169.82 | $181.97 | $263.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $309.03 / $549.54
| Facility | | $158.49 | $309.03 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.60 / $0.60 / $0.60
| Professional | | $0.60 | $0.60 | $0.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $275.42 / $288.40
| Facility | | $151.36 | $275.42 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $186.21 / $281.84
| Professional | | $151.36 | $186.21 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $1,949.84 / $1,949.84
| Facility | | $1,949.84 | $1,949.84 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,454.71 / $2,754.23
| Professional | | $2,454.71 | $2,454.71 | $2,754.23 |