- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $320.39 / $320.39 / $320.39
| Facility | | $320.39 | $320.39 | $320.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.18 / $320.39 / $320.39
| Professional | | $253.18 | $320.39 | $320.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $8,639.91 / $79,506.39
| Facility | | $5,000.00 | $8,639.91 | $79,506.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.48 / $187.29 / $187.29
| Professional | | $180.48 | $187.29 | $187.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $247.20 / $247.20 / $247.20
| Facility | | $247.20 | $247.20 | $247.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.76 / $205.76 / $205.76
| Professional | | $205.76 | $205.76 | $205.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $224.14 / $224.14 / $407.64
| Facility | | $224.14 | $224.14 | $407.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $320.39 / $320.39 / $320.39
| Facility | | $320.39 | $320.39 | $320.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.18 / $320.39 / $320.39
| Professional | | $253.18 | $320.39 | $320.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $247.20 / $247.20 / $247.20
| Facility | | $247.20 | $247.20 | $247.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.76 / $205.76 / $205.76
| Professional | | $205.76 | $205.76 | $205.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.20 / $222.20 / $222.20
| Professional | | $222.20 | $222.20 | $222.20 |