- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $495.04 / $495.04 / $495.04
| Facility | | $495.04 | $495.04 | $495.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $466.47 / $550.66 / $671.99
| Professional | | $466.47 | $550.66 | $671.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $682.50 / $2,153.44 / $6,508.59
| Facility | | $682.50 | $2,153.44 | $6,508.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $465.52 / $810.92 / $1,106.45
| Professional | | $465.52 | $810.92 | $1,106.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.58 / $1,463.08 / $1,884.17
| Facility | | $1,202.58 | $1,463.08 | $1,884.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.91 / $823.41 / $823.41
| Professional | | $741.91 | $823.41 | $823.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $655.36 / $700.00 / $794.31
| Facility | | $655.36 | $700.00 | $794.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $511.00 / $700.00 / $1,308.75
| Professional | | $511.00 | $700.00 | $1,308.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $917.35 / $917.35 / $963.22
| Professional | | $917.35 | $917.35 | $963.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $614.49 / $614.49 / $614.49
| Professional | | $614.49 | $614.49 | $614.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,291.83 / $6,508.59 / $6,508.59
| Facility | | $2,291.83 | $6,508.59 | $6,508.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.25 / $565.25 / $1,106.45
| Professional | | $427.25 | $565.25 | $1,106.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $480.00 / $480.00 / $480.00
| Facility | | $480.00 | $480.00 | $480.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.52 / $605.64 / $1,275.93
| Professional | | $434.52 | $605.64 | $1,275.93 |