- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $314.63 / $314.63 / $314.63
| Facility | | $314.63 | $314.63 | $314.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.63 / $314.63 / $431.72
| Professional | | $314.63 | $314.63 | $431.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $437.82 / $1,360.16 / $3,405.00
| Facility | | $437.82 | $1,360.16 | $3,405.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.10 / $506.72 / $703.22
| Professional | | $290.10 | $506.72 | $703.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.52 / $416.52 / $1,237.06
| Facility | | $416.52 | $416.52 | $1,237.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.53 / $555.54 / $555.54
| Professional | | $471.53 | $555.54 | $555.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.16 / $416.52 / $504.82
| Facility | | $400.16 | $416.52 | $504.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.12 / $400.16 / $931.88
| Professional | | $292.12 | $400.16 | $931.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $583.02 / $583.02 / $612.16
| Professional | | $583.02 | $583.02 | $612.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $406.88 / $406.88 / $406.88
| Professional | | $406.88 | $406.88 | $406.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,631.67 / $3,405.00 / $3,405.00
| Facility | | $1,631.67 | $3,405.00 | $3,405.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.25 / $359.24 / $703.22
| Professional | | $266.25 | $359.24 | $703.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $853.88 / $853.88 / $853.88
| Facility | | $853.88 | $853.88 | $853.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.14 / $359.24 / $810.93
| Professional | | $279.14 | $359.24 | $810.93 |