- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.77 / $1,152.75 / $2,030.00
| Facility | | $505.77 | $1,152.75 | $2,030.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.25 / $435.00 / $616.25
| Professional | | $384.25 | $435.00 | $616.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.08 / $255.08 / $769.64
| Professional | | $255.08 | $255.08 | $769.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $471.25 / $1,017.90 / $2,531.75
| Facility | | $471.25 | $1,017.90 | $2,531.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $883.00 / $3,494.50 / $3,494.50
| Professional | | $883.00 | $3,494.50 | $3,494.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.00 / $942.50 / $1,631.25
| Facility | | $319.00 | $942.50 | $1,631.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.50 / $942.50 / $1,573.25
| Professional | | $507.50 | $942.50 | $1,573.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.25 / $716.04 / $1,314.64
| Professional | | $616.25 | $716.04 | $1,314.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $471.25 / $1,017.90 / $2,609.59
| Facility | | $471.25 | $1,017.90 | $2,609.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.25 / $790.25 / $1,667.50
| Professional | | $471.25 | $790.25 | $1,667.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.50 / $435.00 / $1,098.80
| Professional | | $304.50 | $435.00 | $1,098.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $725.00 / $833.73 / $833.73
| Facility | | $725.00 | $833.73 | $833.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.25 / $725.00 / $871.39
| Professional | | $616.25 | $725.00 | $871.39 |