- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $551.53 / $551.53 / $551.53
| Facility | | $551.53 | $551.53 | $551.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $543.29 / $551.53 / $919.11
| Professional | | $543.29 | $551.53 | $919.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $277.64 / $1,232.71 / $6,924.79
| Facility | | $277.64 | $1,232.71 | $6,924.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $545.48 / $865.13 / $1,232.71
| Professional | | $545.48 | $865.13 | $1,232.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,339.79 / $1,630.01 / $2,099.14
| Facility | | $1,339.79 | $1,630.01 | $2,099.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $826.57 / $1,120.00 / $1,120.00
| Professional | | $826.57 | $1,120.00 | $1,120.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $719.79 / $730.14 / $884.95
| Facility | | $719.79 | $730.14 | $884.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $525.45 / $719.79 / $1,290.00
| Professional | | $525.45 | $719.79 | $1,290.00 |
- 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
- $1,022.02 / $1,022.02 / $1,073.11
| Professional | | $1,022.02 | $1,022.02 | $1,073.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $694.65 / $694.65 / $694.65
| Professional | | $694.65 | $694.65 | $694.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,258.71 / $6,924.79 / $6,924.79
| Facility | | $2,258.71 | $6,924.79 | $6,924.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $493.08 / $674.75 / $1,232.71
| Professional | | $493.08 | $674.75 | $1,232.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $545.48 / $674.75 / $1,093.39
| Professional | | $545.48 | $674.75 | $1,093.39 |