- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $131.83 / $131.83
| Facility | | $131.83 | $131.83 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $144.54 / $416.87
| Professional | | $117.49 | $144.54 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $309.03 / $1,659.59
| Facility | | $269.15 | $309.03 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $218.78 / $309.03
| Professional | | $120.23 | $218.78 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $173.78 / $524.81
| Facility | | $173.78 | $173.78 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $251.19 / $251.19
| Professional | | $194.98 | $251.19 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $173.78 / $208.93
| Facility | | $165.96 | $173.78 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $120.23 / $177.83
| Professional | | $120.23 | $120.23 | $177.83 |
- 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
- $263.03 / $263.03 / $398.11
| Professional | | $263.03 | $263.03 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $169.82 / $169.82
| Professional | | $169.82 | $169.82 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $309.03 / $1,659.59
| Facility | | $269.15 | $309.03 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $229.09 / $354.81
| Professional | | $120.23 | $229.09 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.21 / $165.96 / $363.08
| Facility | | $0.21 | $165.96 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $165.96 / $263.03
| Professional | | $117.49 | $165.96 | $263.03 |