- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $436.52 / $436.52
| Facility | | $436.52 | $436.52 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $154.88 / $831.76
| Professional | | $83.18 | $154.88 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $707.95
| Facility | | $707.95 | $707.95 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $208.93 / $1,202.26
| Professional | | $91.20 | $208.93 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $363.08 / $363.08
| Facility | | $363.08 | $363.08 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $141.25 / $141.25
| Professional | | $112.20 | $141.25 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $204.17 / $204.17
| Facility | | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $181.97 / $389.05
| Professional | | $91.20 | $181.97 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $218.78 / $257.04
| Professional | | $218.78 | $218.78 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $263.03 / $380.19
| Professional | | $151.36 | $263.03 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.72 / $97.72 / $97.72
| Facility | | $97.72 | $97.72 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $707.95
| Facility | | $707.95 | $707.95 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $208.93 / $1,202.26
| Professional | | $91.20 | $208.93 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $151.36 / $151.36
| Facility | | $91.20 | $151.36 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $162.18 / $346.74
| Professional | | $91.20 | $162.18 | $346.74 |