- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.97 / $530.61 / $10,375.54
| Facility | | $398.97 | $530.61 | $10,375.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.32 / $481.76 / $710.40
| Professional | | $372.32 | $481.76 | $710.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $703.47 / $1,190.06 / $1,590.34
| Professional | | $703.47 | $1,190.06 | $1,590.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $408.36 / $726.67 / $1,378.64
| Facility | | $408.36 | $726.67 | $1,378.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $578.45 / $1,104.31 / $4,088.00
| Professional | | $578.45 | $1,104.31 | $4,088.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $801.53 / $1,156.80 / $1,525.43
| Facility | | $801.53 | $1,156.80 | $1,525.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $703.00 / $1,044.21 / $1,426.34
| Professional | | $703.00 | $1,044.21 | $1,426.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $566.26 / $844.85 / $1,059.25
| Professional | | $566.26 | $844.85 | $1,059.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $2,000.00 / $2,000.00
| Facility | | $2,000.00 | $2,000.00 | $2,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $542.55 / $975.46 / $1,517.38
| Professional | | $542.55 | $975.46 | $1,517.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $838.10 / $1,025.50 / $1,324.60
| Professional | | $838.10 | $1,025.50 | $1,324.60 |