- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $478.63 / $478.63
| Facility | | $478.63 | $478.63 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $616.60 / $1,513.56
| Professional | | $446.68 | $616.60 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,071.52 / $6,760.83
| Facility | | $1,047.13 | $1,071.52 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $851.14 / $1,122.02
| Professional | | $489.78 | $851.14 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,445.44 / $1,905.46
| Facility | | $1,230.27 | $1,445.44 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $741.31 / $741.31
| Professional | | $724.44 | $741.31 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $707.95
| Facility | | $707.95 | $707.95 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $524.81 / $741.31
| Professional | | $524.81 | $524.81 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $954.99 / $1,479.11
| Professional | | $954.99 | $954.99 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $660.69 / $660.69
| Professional | | $660.69 | $660.69 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,071.52 / $6,760.83
| Facility | | $1,047.13 | $1,071.52 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $851.14 / $1,230.27
| Professional | | $489.78 | $851.14 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.85 / $602.56 / $1,479.11
| Facility | | $0.85 | $602.56 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $645.65 / $954.99
| Professional | | $457.09 | $645.65 | $954.99 |