- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $370.50 / $1,418.00 / $4,050.00
| Facility | | $370.50 | $1,418.00 | $4,050.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.75 / $375.00 / $525.00
| Professional | | $318.75 | $375.00 | $525.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $0.03 / $697.32
| Professional | | $0.02 | $0.03 | $697.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $720.94 / $871.87 / $1,373.42
| Facility | | $720.94 | $871.87 | $1,373.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,471.54 / $1,471.54 / $1,471.54
| Professional | | $1,471.54 | $1,471.54 | $1,471.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.00 / $260.00 / $260.00
| Professional | | $260.00 | $260.00 | $260.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $397.00 / $397.00 / $397.00
| Facility | | $397.00 | $397.00 | $397.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $633.91 / $871.87 / $1,445.38
| Facility | | $633.91 | $871.87 | $1,445.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,471.54 / $1,471.54 / $1,471.54
| Professional | | $1,471.54 | $1,471.54 | $1,471.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $692.88 / $816.32 / $1,077.36
| Facility | | $692.88 | $816.32 | $1,077.36 |