- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $502.76 / $502.76 / $502.76
| Facility | | $502.76 | $502.76 | $502.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $439.45 / $502.76 / $692.08
| Professional | | $439.45 | $502.76 | $692.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $966.15 / $1,826.98 / $5,042.08
| Facility | | $966.15 | $1,826.98 | $5,042.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $449.48 / $873.26 / $1,123.70
| Professional | | $449.48 | $873.26 | $1,123.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $665.57 / $665.57 / $1,976.74
| Facility | | $665.57 | $665.57 | $1,976.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $828.82 / $1,020.97 / $1,020.97
| Professional | | $828.82 | $1,020.97 | $1,020.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $582.20 / $665.57 / $806.68
| Facility | | $582.20 | $665.57 | $806.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.01 / $582.20 / $1,043.25
| Professional | | $425.01 | $582.20 | $1,043.25 |
- 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
- $931.64 / $931.64 / $978.22
| Professional | | $931.64 | $931.64 | $978.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.29 / $548.29 / $548.29
| Professional | | $548.29 | $548.29 | $548.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,826.98 / $5,042.08 / $5,042.08
| Facility | | $1,826.98 | $5,042.08 | $5,042.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.54 / $615.08 / $1,123.70
| Professional | | $430.54 | $615.08 | $1,123.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.36 / $500.36 / $500.36
| Facility | | $500.36 | $500.36 | $500.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.09 / $647.90 / $1,022.83
| Professional | | $438.09 | $647.90 | $1,022.83 |