- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $954.99 / $7,943.28
| Facility | | $512.86 | $954.99 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $512.86 / $1,202.26
| Professional | | $398.11 | $512.86 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $891.25 / $1,174.90
| Professional | | $537.03 | $891.25 | $1,174.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $812.83 / $977.24
| Professional | | $354.81 | $812.83 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $741.31 / $1,096.48
| Facility | | $512.86 | $741.31 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $831.76 / $1,258.93
| Professional | | $602.56 | $831.76 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $758.58 / $812.83
| Facility | | $645.65 | $758.58 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $676.08 / $1,000.00
| Facility | | $446.68 | $676.08 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $741.31 / $1,096.48
| Professional | | $79.43 | $741.31 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $2,187.76 / $2,187.76
| Facility | | $2,187.76 | $2,187.76 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $933.25 / $1,258.93
| Professional | | $724.44 | $933.25 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $10,232.93 / $37,153.52
| Facility | | $2,454.71 | $10,232.93 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $851.14 / $1,174.90
| Professional | | $549.54 | $851.14 | $1,174.90 |