- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $819.99 / $3,839.00 / $8,427.00
| Facility | | $819.99 | $3,839.00 | $8,427.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $705.29 / $819.99 / $1,021.91
| Professional | | $705.29 | $819.99 | $1,021.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,431.95 / $7,827.00 / $19,139.18
| Facility | | $6,431.95 | $7,827.00 | $19,139.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $855.76 / $888.05 / $888.05
| Professional | | $855.76 | $888.05 | $888.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $838.30 / $1,089.89 / $1,739.89
| Professional | | $838.30 | $1,089.89 | $1,739.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,046.77 / $1,407.85 / $1,407.85
| Professional | | $1,046.77 | $1,407.85 | $1,407.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.00 / $4,761.00 / $8,427.00
| Facility | | $832.00 | $4,761.00 | $8,427.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $705.29 / $852.85 / $2,232.71
| Professional | | $705.29 | $852.85 | $2,232.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $909.70 / $2,151.80
| Professional | | $6.00 | $909.70 | $2,151.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $838.30 / $1,093.95 / $1,805.62
| Professional | | $838.30 | $1,093.95 | $1,805.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $784.83 / $842.11 / $842.11
| Facility | | $784.83 | $842.11 | $842.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $784.83 / $842.11 / $889.62
| Professional | | $784.83 | $842.11 | $889.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,334.00 / $2,824.00 / $5,678.00
| Facility | | $1,334.00 | $2,824.00 | $5,678.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $780.63 / $1,040.83 / $1,712.50
| Professional | | $780.63 | $1,040.83 | $1,712.50 |