- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $381.86 / $381.86 / $381.86
| Facility | | $381.86 | $381.86 | $381.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.67 / $404.25 / $1,338.01
| Professional | | $314.67 | $404.25 | $1,338.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.84 / $1,864.80 / $1,864.80
| Facility | | $842.84 | $1,864.80 | $1,864.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $390.86 / $671.12 / $3,516.49
| Professional | | $390.86 | $671.12 | $3,516.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $472.23 / $713.08 / $965.97
| Professional | | $472.23 | $713.08 | $965.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $441.14 / $441.14 / $441.14
| Facility | | $441.14 | $441.14 | $441.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.37 / $588.91 / $1,098.27
| Professional | | $376.37 | $588.91 | $1,098.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $450.71 / $450.71 / $450.71
| Facility | | $450.71 | $450.71 | $450.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.04 / $401.66 / $694.84
| Professional | | $218.04 | $401.66 | $694.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.35 / $922.55 / $1,191.28
| Professional | | $467.35 | $922.55 | $1,191.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $599.98 / $1,018.98 / $1,198.80
| Professional | | $599.98 | $1,018.98 | $1,198.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.84 / $1,864.80 / $1,864.80
| Facility | | $842.84 | $1,864.80 | $1,864.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $418.11 / $617.59 / $3,516.49
| Professional | | $418.11 | $617.59 | $3,516.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.68 / $387.93 / $1,238.76
| Professional | | $316.68 | $387.93 | $1,238.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $406.01 / $570.45 / $1,031.44
| Professional | | $406.01 | $570.45 | $1,031.44 |