- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $707.95
| Facility | | $501.19 | $501.19 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $223.87 / $537.03
| Professional | | $147.91 | $223.87 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $549.54 / $1,000.00
| Facility | | $275.42 | $549.54 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $281.84 / $281.84
| Professional | | $275.42 | $281.84 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $575.44 / $1,071.52
| Facility | | $213.80 | $575.44 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $204.17 / $457.09
| Professional | | $114.82 | $204.17 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $281.84 / $416.87
| Facility | | $275.42 | $281.84 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $288.40 / $346.74
| Professional | | $275.42 | $288.40 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $204.17 / $239.88
| Professional | | $204.17 | $204.17 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $549.54 / $1,000.00
| Facility | | $416.87 | $549.54 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $234.42 / $288.40
| Professional | | $234.42 | $234.42 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $275.42 / $389.05
| Professional | | $275.42 | $275.42 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $114.82 / $275.42
| Professional | | $114.82 | $114.82 | $275.42 |