- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $480.14 / $480.14 / $480.14
| Facility | | $480.14 | $480.14 | $480.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $480.14 / $518.57 / $677.48
| Professional | | $480.14 | $518.57 | $677.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $635.38 / $2,004.76 / $6,560.56
| Facility | | $635.38 | $2,004.76 | $6,560.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.24 / $796.35 / $1,073.17
| Professional | | $469.24 | $796.35 | $1,073.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,166.39 / $1,419.04 / $1,827.46
| Facility | | $1,166.39 | $1,419.04 | $1,827.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $719.57 / $903.65 / $903.65
| Professional | | $719.57 | $903.65 | $903.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $635.62 / $732.96 / $770.38
| Facility | | $635.62 | $732.96 | $770.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.05 / $535.05 / $1,313.63
| Professional | | $535.05 | $535.05 | $1,313.63 |
- 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
- $889.74 / $889.74 / $934.23
| Professional | | $889.74 | $889.74 | $934.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $717.51 / $717.51 / $717.51
| Professional | | $717.51 | $717.51 | $717.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,300.11 / $6,560.56 / $6,560.56
| Facility | | $2,300.11 | $6,560.56 | $6,560.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $418.39 / $557.45 / $1,073.17
| Professional | | $418.39 | $557.45 | $1,073.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,381.17 / $1,381.17 / $1,381.17
| Facility | | $1,381.17 | $1,381.17 | $1,381.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.66 / $587.41 / $1,073.17
| Professional | | $430.66 | $587.41 | $1,073.17 |