- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $165.96 / $165.96
| Facility | | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $177.83 / $371.54
| Professional | | $151.36 | $177.83 | $371.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $389.05 / $1,995.26
| Facility | | $338.84 | $389.05 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $269.15 / $389.05
| Professional | | $162.18 | $269.15 | $389.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $218.78 / $660.69
| Facility | | $218.78 | $218.78 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $338.84 / $338.84
| Professional | | $275.42 | $338.84 | $338.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $218.78 / $263.03
| Facility | | $218.78 | $218.78 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $162.18 / $218.78
| Professional | | $162.18 | $162.18 | $218.78 |
- 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
- $331.13 / $331.13 / $501.19
| Professional | | $331.13 | $331.13 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $213.80 / $213.80
| Professional | | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $389.05 / $1,995.26
| Facility | | $338.84 | $389.05 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $288.40 / $426.58
| Professional | | $162.18 | $288.40 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.25 / $239.88 / $436.52
| Facility | | $0.25 | $239.88 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $239.88 / $331.13
| Professional | | $154.88 | $239.88 | $331.13 |