- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $1,230.27 / $7,943.28
| Facility | | $933.25 | $1,230.27 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $512.86 / $1,071.52
| Professional | | $346.74 | $512.86 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $446.68 / $446.68
| Facility | | $446.68 | $446.68 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $741.31 / $1,258.93
| Professional | | $467.74 | $741.31 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $891.25 / $1,047.13
| Professional | | $457.09 | $891.25 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $724.44 / $1,548.82
| Facility | | $478.63 | $724.44 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $707.95 / $1,202.26
| Professional | | $588.84 | $707.95 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $776.25 / $933.25
| Facility | | $588.84 | $776.25 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $707.95 / $1,047.13
| Facility | | $457.09 | $707.95 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $758.58 / $1,174.90
| Professional | | $79.43 | $758.58 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $7,413.10 / $8,912.51
| Facility | | $5,754.40 | $7,413.10 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,023.29 / $1,230.27
| Professional | | $870.96 | $1,023.29 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $4,365.16 / $10,000.00
| Facility | | $389.05 | $4,365.16 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $758.58 / $1,202.26
| Professional | | $489.78 | $758.58 | $1,202.26 |