- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.78 / $900.25 / $2,838.27
| Facility | | $416.78 | $900.25 | $2,838.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.78 / $416.78 / $416.78
| Professional | | $416.78 | $416.78 | $416.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.78 / $1,029.45 / $2,154.75
| Facility | | $416.78 | $1,029.45 | $2,154.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.78 / $416.78 / $416.78
| Professional | | $416.78 | $416.78 | $416.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $168.00 / $291.75 / $416.78
| Facility | | $168.00 | $291.75 | $416.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $80.00 / $80.00
| Facility | | $80.00 | $80.00 | $80.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.33 / $297.63 / $1,044.68
| Facility | | $263.33 | $297.63 | $1,044.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.78 / $507.69 / $608.27
| Professional | | $416.78 | $507.69 | $608.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $666.85 / $1,979.71 / $1,979.71
| Facility | | $666.85 | $1,979.71 | $1,979.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,075.56 / $2,075.56 / $3,125.85
| Professional | | $2,075.56 | $2,075.56 | $3,125.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.78 / $416.78 / $625.16
| Facility | | $416.78 | $416.78 | $625.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.78 / $416.78 / $520.98
| Professional | | $416.78 | $416.78 | $520.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.10 / $500.14 / $871.07
| Professional | | $375.10 | $500.14 | $871.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.02 / $325.52 / $1,258.61
| Facility | | $288.02 | $325.52 | $1,258.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.10 / $458.46 / $729.37
| Professional | | $375.10 | $458.46 | $729.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.11 / $175.07 / $295.76
| Professional | | $165.11 | $175.07 | $295.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.71 / $166.71 / $416.78
| Professional | | $166.71 | $166.71 | $416.78 |