- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $324.58 / $324.58 / $324.58
| Facility | | $324.58 | $324.58 | $324.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.57 / $324.58 / $418.28
| Professional | | $301.57 | $324.58 | $418.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $421.79 / $1,191.08 / $3,528.63
| Facility | | $421.79 | $1,191.08 | $3,528.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.16 / $446.73 / $725.46
| Professional | | $272.16 | $446.73 | $725.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $788.47 / $959.27 / $1,235.35
| Facility | | $788.47 | $959.27 | $1,235.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.08 / $679.58 / $679.58
| Professional | | $535.08 | $679.58 | $679.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $372.88 / $429.68 / $520.79
| Facility | | $372.88 | $429.68 | $520.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.20 / $372.88 / $680.25
| Professional | | $272.20 | $372.88 | $680.25 |
- 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
- $601.47 / $601.47 / $631.54
| Professional | | $601.47 | $601.47 | $631.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.68 / $425.68 / $425.68
| Facility | | $425.68 | $425.68 | $425.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.68 / $425.68 / $433.44
| Professional | | $425.68 | $425.68 | $433.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,191.08 / $3,528.63 / $3,528.63
| Facility | | $1,191.08 | $3,528.63 | $3,528.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.07 / $370.61 / $725.46
| Professional | | $247.07 | $370.61 | $725.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.07 / $370.61 / $707.23
| Professional | | $247.07 | $370.61 | $707.23 |