- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $509.95 / $509.95 / $509.95
| Facility | | $509.95 | $509.95 | $509.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $462.66 / $509.95 / $718.22
| Professional | | $462.66 | $509.95 | $718.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $667.40 / $2,073.39 / $5,543.92
| Facility | | $667.40 | $2,073.39 | $5,543.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $459.09 / $710.46 / $1,139.79
| Professional | | $459.09 | $710.46 | $1,139.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,238.80 / $1,507.14 / $1,940.91
| Facility | | $1,238.80 | $1,507.14 | $1,940.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $840.68 / $1,035.58 / $1,035.58
| Professional | | $840.68 | $1,035.58 | $1,035.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.94 / $675.10 / $818.22
| Facility | | $612.94 | $675.10 | $818.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.45 / $612.94 / $1,098.38
| Professional | | $447.45 | $612.94 | $1,098.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $944.98 / $944.98 / $992.23
| Professional | | $944.98 | $944.98 | $992.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $556.14 / $556.14 / $556.14
| Professional | | $556.14 | $556.14 | $556.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,105.06 / $5,543.92 / $5,543.92
| Facility | | $2,105.06 | $5,543.92 | $5,543.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.70 / $623.88 / $1,139.79
| Professional | | $436.70 | $623.88 | $1,139.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.70 / $363.92 / $657.98
| Facility | | $0.70 | $363.92 | $657.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.70 / $623.88 / $944.98
| Professional | | $436.70 | $623.88 | $944.98 |