- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $807.50 / $1,370.85 / $2,895.22
| Facility | | $807.50 | $1,370.85 | $2,895.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $665.00 / $779.00 / $893.00
| Professional | | $665.00 | $779.00 | $893.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,111.50 / $1,330.00 / $1,681.50
| Facility | | $1,111.50 | $1,330.00 | $1,681.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58.70 / $100.00 / $8,616.50
| Facility | | $58.70 | $100.00 | $8,616.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.67 / $1,011.75 / $2,872.13
| Facility | | $794.67 | $1,011.75 | $2,872.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $432.25 / $617.50 / $1,552.33
| Professional | | $432.25 | $617.50 | $1,552.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $570.00 / $570.00 / $830.38
| Professional | | $570.00 | $570.00 | $830.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.00 / $380.00 / $1,091.54
| Professional | | $380.00 | $380.00 | $1,091.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $950.00 / $950.00 / $950.00
| Professional | | $950.00 | $950.00 | $950.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $901.55 / $1,667.25 / $2,760.23
| Facility | | $901.55 | $1,667.25 | $2,760.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,020.78 / $1,157.05 / $1,386.28
| Professional | | $1,020.78 | $1,157.05 | $1,386.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $855.00 / $855.00 / $855.00
| Facility | | $855.00 | $855.00 | $855.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $399.00 / $570.00 / $1,092.50
| Professional | | $399.00 | $570.00 | $1,092.50 |