- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $329.80 / $329.80 / $329.80
| Facility | | $329.80 | $329.80 | $329.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.62 / $258.33 / $329.80
| Professional | | $211.62 | $258.33 | $329.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.93 / $109.93 / $1,137.11
| Professional | | $109.93 | $109.93 | $1,137.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $418.36 / $418.36 / $418.36
| Facility | | $418.36 | $418.36 | $418.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.04 / $883.49 / $1,355.30
| Facility | | $756.04 | $883.49 | $1,355.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.42 / $740.06 / $840.98
| Professional | | $325.42 | $740.06 | $840.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $211.62 / $329.80 / $961.91
| Facility | | $211.62 | $329.80 | $961.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $211.62 / $329.80 / $961.91
| Facility | | $211.62 | $329.80 | $961.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.26 / $158.44 / $760.23
| Professional | | $123.26 | $158.44 | $760.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $70.00 / $758.53
| Professional | | $50.00 | $70.00 | $758.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $211.62 / $329.80 / $961.91
| Facility | | $211.62 | $329.80 | $961.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $459.00 / $655.61 / $919.53
| Professional | | $459.00 | $655.61 | $919.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.66 / $1,305.44 / $1,305.44
| Facility | | $549.66 | $1,305.44 | $1,305.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,099.32 / $1,099.32 / $1,368.65
| Professional | | $1,099.32 | $1,099.32 | $1,368.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $585.26 / $585.26 / $585.26
| Professional | | $585.26 | $585.26 | $585.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $798.66 / $1,500.57 / $1,500.57
| Professional | | $798.66 | $1,500.57 | $1,500.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.43 / $147.91 / $517.69
| Professional | | $115.43 | $147.91 | $517.69 |