- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $831.76 / $3,019.95
| Facility | | $707.95 | $831.76 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $831.76 / $2,511.89
| Professional | | $478.63 | $831.76 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,819.70 / $4,466.84
| Facility | | $794.33 | $1,819.70 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $812.83 / $4,677.35
| Professional | | $245.47 | $812.83 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $724.44 / $1,778.28
| Facility | | $588.84 | $724.44 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,479.11 / $2,570.40
| Facility | | $616.60 | $1,479.11 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $1,380.38 / $2,238.72
| Professional | | $281.84 | $1,380.38 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $1,000.00 / $7,079.46
| Facility | | $158.49 | $1,000.00 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $891.25 / $1,380.38
| Professional | | $93.33 | $891.25 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $977.24 / $1,819.70
| Professional | | $691.83 | $977.24 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,819.70 / $4,466.84
| Facility | | $794.33 | $1,819.70 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $812.83 / $4,677.35
| Professional | | $245.47 | $812.83 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $1,000.00 / $1,819.70
| Facility | | $141.25 | $1,000.00 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $912.01 / $2,041.74
| Professional | | $245.47 | $912.01 | $2,041.74 |