- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $288.40 / $288.40
| Facility | | $288.40 | $288.40 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $288.40 / $398.11
| Professional | | $245.47 | $288.40 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $575.44 / $2,137.96
| Facility | | $407.38 | $575.44 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $407.38 / $467.74
| Professional | | $234.42 | $407.38 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $616.60 / $630.96
| Facility | | $616.60 | $616.60 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $363.08 / $489.78
| Professional | | $363.08 | $363.08 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $302.00 / $512.86
| Facility | | $302.00 | $302.00 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $302.00 / $524.81
| Professional | | $302.00 | $302.00 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $363.08 / $457.09
| Professional | | $234.42 | $363.08 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $416.87
| Professional | | $398.11 | $398.11 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $575.44 / $2,137.96
| Facility | | $407.38 | $575.44 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $407.38 / $512.86
| Professional | | $234.42 | $407.38 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.34 / $181.97 / $354.81
| Facility | | $0.34 | $181.97 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $363.08 / $588.84
| Professional | | $234.42 | $363.08 | $588.84 |