- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $391.88 / $1,091.42 / $2,849.37
| Facility | | $391.88 | $1,091.42 | $2,849.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.54 / $386.03 / $701.88
| Professional | | $327.54 | $386.03 | $701.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $614.14 / $1,865.83 / $3,271.11
| Facility | | $614.14 | $1,865.83 | $3,271.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $310.00 / $467.92
| Professional | | $5.00 | $310.00 | $467.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $584.90 / $584.90 / $584.90
| Facility | | $584.90 | $584.90 | $584.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $408.71 / $1,220.82 / $2,718.23
| Facility | | $408.71 | $1,220.82 | $2,718.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.00 / $403.63 / $1,134.19
| Professional | | $310.00 | $403.63 | $1,134.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,500.00 / $3,500.00 / $3,500.00
| Facility | | $3,500.00 | $3,500.00 | $3,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,924.50 / $2,924.50 / $4,386.75
| Professional | | $2,924.50 | $2,924.50 | $4,386.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $368.49 / $584.90 / $701.88
| Facility | | $368.49 | $584.90 | $701.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $555.66 / $584.90 / $731.13
| Professional | | $555.66 | $584.90 | $731.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $701.88 / $1,316.03
| Professional | | $380.19 | $701.88 | $1,316.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $368.49 / $584.90 / $1,277.44
| Facility | | $368.49 | $584.90 | $1,277.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.95 / $475.29 / $986.37
| Professional | | $311.95 | $475.29 | $986.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $210.56 / $245.66 / $584.90
| Facility | | $210.56 | $245.66 | $584.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.66 / $336.98 / $481.40
| Professional | | $245.66 | $336.98 | $481.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.11 / $288.83 / $584.90
| Professional | | $228.11 | $288.83 | $584.90 |