- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $194.98 / $194.98
| Facility | | $194.98 | $194.98 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $251.19 / $537.03
| Professional | | $194.98 | $251.19 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $457.09 / $2,818.38
| Facility | | $398.11 | $457.09 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $338.84 / $457.09
| Professional | | $208.93 | $338.84 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $263.03 / $794.33
| Facility | | $263.03 | $263.03 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $398.11 / $398.11
| Professional | | $323.59 | $398.11 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $331.13 / $338.84
| Facility | | $263.03 | $331.13 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $245.47 / $338.84
| Professional | | $245.47 | $245.47 | $338.84 |
- 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
- $389.05 / $389.05 / $602.56
| Professional | | $389.05 | $389.05 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $288.40 / $288.40
| Professional | | $288.40 | $288.40 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $457.09 / $2,818.38
| Facility | | $398.11 | $457.09 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $346.74 / $588.84
| Professional | | $218.78 | $346.74 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.35 / $331.13 / $602.56
| Facility | | $0.35 | $331.13 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $316.23 / $389.05
| Professional | | $194.98 | $316.23 | $389.05 |