- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.18 / $398.18 / $398.18
| Facility | | $398.18 | $398.18 | $398.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.18 / $398.18 / $556.22
| Professional | | $398.18 | $398.18 | $556.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.77 / $1,112.46 / $5,182.72
| Facility | | $389.77 | $1,112.46 | $5,182.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $370.70 / $652.26 / $889.97
| Professional | | $370.70 | $652.26 | $889.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $527.14 / $527.14 / $1,565.61
| Facility | | $527.14 | $527.14 | $1,565.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $596.75 / $702.55 / $702.55
| Professional | | $596.75 | $702.55 | $702.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $511.34 / $527.14 / $638.89
| Facility | | $511.34 | $527.14 | $638.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.28 / $511.34 / $1,126.50
| Professional | | $373.28 | $511.34 | $1,126.50 |
- 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
- $737.86 / $737.86 / $774.75
| Professional | | $737.86 | $737.86 | $774.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $528.86 / $528.86 / $528.86
| Professional | | $528.86 | $528.86 | $528.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,972.65 / $5,182.72 / $5,182.72
| Facility | | $1,972.65 | $5,182.72 | $5,182.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.22 / $454.65 / $889.97
| Professional | | $340.22 | $454.65 | $889.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.65 / $340.22 / $453.24
| Facility | | $0.65 | $340.22 | $453.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.99 / $454.65 / $889.97
| Professional | | $355.99 | $454.65 | $889.97 |