- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.69 / $470.69 / $470.69
| Facility | | $470.69 | $470.69 | $470.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $470.69 / $518.82 / $689.95
| Professional | | $470.69 | $518.82 | $689.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $840.80 / $2,651.88 / $5,140.93
| Facility | | $840.80 | $2,651.88 | $5,140.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $487.64 / $820.30 / $1,052.03
| Professional | | $487.64 | $820.30 | $1,052.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,497.87 / $5,497.87 / $16,328.67
| Facility | | $5,497.87 | $5,497.87 | $16,328.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $728.50 / $728.50 / $753.10
| Professional | | $728.50 | $728.50 | $753.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.27 / $616.27 / $616.27
| Facility | | $616.27 | $616.27 | $616.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $449.88 / $616.27 / $1,279.50
| Professional | | $449.88 | $616.27 | $1,279.50 |
- 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
- $872.22 / $872.22 / $915.83
| Professional | | $872.22 | $872.22 | $915.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $667.15 / $667.15 / $667.15
| Professional | | $667.15 | $667.15 | $667.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,240.57 / $5,140.93 / $5,140.93
| Facility | | $2,240.57 | $5,140.93 | $5,140.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $391.74 / $553.58 / $1,052.03
| Professional | | $391.74 | $553.58 | $1,052.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $420.81 / $585.26 / $1,052.03
| Professional | | $420.81 | $585.26 | $1,052.03 |