- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $289.12 / $289.12 / $289.12
| Facility | | $289.12 | $289.12 | $289.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.12 / $321.61 / $423.77
| Professional | | $289.12 | $321.61 | $423.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $592.04 / $1,884.99 / $3,157.08
| Facility | | $592.04 | $1,884.99 | $3,157.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.35 / $491.55 / $646.21
| Professional | | $274.35 | $491.55 | $646.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $722.51 / $854.47 / $1,100.40
| Facility | | $722.51 | $854.47 | $1,100.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $476.63 / $605.34 / $605.34
| Professional | | $476.63 | $605.34 | $605.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $419.48 / $419.48 / $486.35
| Facility | | $419.48 | $419.48 | $486.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.22 / $419.48 / $786.00
| Professional | | $306.22 | $419.48 | $786.00 |
- 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
- $535.76 / $535.76 / $562.54
| Professional | | $535.76 | $535.76 | $562.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $362.40 / $362.40 / $362.40
| Facility | | $362.40 | $362.40 | $362.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $483.08 / $483.08 / $483.08
| Professional | | $483.08 | $483.08 | $483.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,376.32 / $3,157.08 / $3,157.08
| Facility | | $1,376.32 | $3,157.08 | $3,157.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.79 / $330.12 / $646.21
| Professional | | $251.79 | $330.12 | $646.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.08 / $353.71 / $646.21
| Professional | | $256.08 | $353.71 | $646.21 |