- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $509.48 / $509.48 / $509.48
| Facility | | $509.48 | $509.48 | $509.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.72 / $509.48 / $656.56
| Professional | | $469.72 | $509.48 | $656.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $1,775.30 / $5,234.93
| Facility | | $875.00 | $1,775.30 | $5,234.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.19 / $875.00 / $1,138.71
| Professional | | $427.19 | $875.00 | $1,138.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,237.63 / $1,505.71 / $1,939.08
| Facility | | $1,237.63 | $1,505.71 | $1,939.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $839.66 / $1,054.73 / $1,054.73
| Professional | | $839.66 | $1,054.73 | $1,054.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $565.73 / $674.46 / $817.45
| Facility | | $565.73 | $674.46 | $817.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.98 / $565.73 / $1,014.00
| Professional | | $412.98 | $565.73 | $1,014.00 |
- 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
- $944.09 / $944.09 / $991.29
| Professional | | $944.09 | $944.09 | $991.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $682.60 / $682.60 / $682.60
| Professional | | $682.60 | $682.60 | $682.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,775.30 / $5,234.93 / $5,234.93
| Facility | | $1,775.30 | $5,234.93 | $5,234.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.82 / $581.72 / $1,138.71
| Professional | | $387.82 | $581.72 | $1,138.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $394.33 / $581.72 / $990.11
| Professional | | $394.33 | $581.72 | $990.11 |