- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $218.78 / $218.78
| Facility | | $218.78 | $218.78 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $288.40 / $602.56
| Professional | | $218.78 | $288.40 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $512.86 / $3,162.28
| Facility | | $446.68 | $512.86 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $389.05 / $512.86
| Professional | | $229.09 | $389.05 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $660.69 / $870.96
| Facility | | $537.03 | $660.69 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $416.87 / $416.87
| Professional | | $331.13 | $416.87 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $316.23 / $354.81
| Facility | | $288.40 | $316.23 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $234.42 / $316.23
| Professional | | $234.42 | $234.42 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $436.52 / $676.08
| Professional | | $436.52 | $436.52 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $316.23 / $316.23
| Professional | | $316.23 | $316.23 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $512.86 / $3,162.28
| Facility | | $446.68 | $512.86 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $389.05 / $562.34
| Professional | | $229.09 | $389.05 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.40 / $316.23 / $691.83
| Facility | | $0.40 | $316.23 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $309.03 / $436.52
| Professional | | $208.93 | $309.03 | $436.52 |