- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,093.55 / $2,954.85 / $4,666.68
| Facility | | $1,093.55 | $2,954.85 | $4,666.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.41 / $328.49 / $476.00
| Professional | | $217.41 | $328.49 | $476.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.23 / $348.60 / $448.20
| Professional | | $208.23 | $348.60 | $448.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.72 / $594.79 / $1,012.18
| Professional | | $318.72 | $594.79 | $1,012.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.44 / $1,632.34 / $3,079.41
| Facility | | $323.44 | $1,632.34 | $3,079.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.97 / $457.69 / $821.44
| Professional | | $275.97 | $457.69 | $821.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $217.41 / $476.50 / $640.62
| Facility | | $217.41 | $476.50 | $640.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.00 / $412.00 / $1,035.35
| Professional | | $378.00 | $412.00 | $1,035.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $442.30 / $524.90 / $735.40
| Professional | | $442.30 | $524.90 | $735.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $902.00 / $1,597.00 / $11,999.00
| Facility | | $902.00 | $1,597.00 | $11,999.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.13 / $376.46 / $717.41
| Professional | | $219.13 | $376.46 | $717.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,019.00 / $9,011.04 / $12,000.00
| Facility | | $1,019.00 | $9,011.04 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,287.00 / $2,287.00 / $2,287.00
| Professional | | $2,287.00 | $2,287.00 | $2,287.00 |