- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $660.69 / $912.01
| Facility | | $204.17 | $660.69 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $239.88 / $562.34
| Professional | | $194.98 | $239.88 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $338.84 / $1,000.00
| Facility | | $218.78 | $338.84 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $288.40 / $1,096.48
| Professional | | $173.78 | $288.40 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $363.08 / $575.44
| Facility | | $288.40 | $363.08 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $275.42 / $288.40
| Professional | | $275.42 | $275.42 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $229.09 / $467.74
| Facility | | $204.17 | $229.09 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $346.74 / $724.44
| Professional | | $158.49 | $346.74 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $3,630.78 / $9,772.37
| Facility | | $83.18 | $3,630.78 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $416.87 / $489.78
| Professional | | $416.87 | $416.87 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $288.40 / $616.60
| Professional | | $288.40 | $288.40 | $616.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $338.84 / $1,000.00
| Facility | | $218.78 | $338.84 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $288.40 / $1,096.48
| Professional | | $173.78 | $288.40 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $288.40 / $346.74
| Facility | | $173.78 | $288.40 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $288.40 / $562.34
| Professional | | $173.78 | $288.40 | $562.34 |