- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,513.56 / $14,454.40
| Facility | | $707.95 | $1,513.56 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $741.31 / $1,995.26
| Professional | | $676.08 | $741.31 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $8,128.31 / $13,489.63
| Facility | | $5,011.87 | $8,128.31 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,412.54 / $3,548.13
| Professional | | $707.95 | $1,412.54 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,238.72 / $3,548.13
| Facility | | $1,905.46 | $2,238.72 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,951.21 / $3,388.44
| Professional | | $1,000.00 | $2,951.21 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,445.44 / $10,000.00
| Facility | | $724.44 | $1,445.44 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,737.80 / $2,187.76
| Professional | | $1,318.26 | $1,737.80 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,513.56 / $15,135.61
| Facility | | $724.44 | $1,513.56 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,288.25 / $5,495.41
| Professional | | $724.44 | $1,288.25 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $70.79
| Professional | | $32.36 | $33.11 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,659.59 / $2,511.89
| Professional | | $1,096.48 | $1,659.59 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $5,888.44 / $5,888.44
| Facility | | $1,905.46 | $5,888.44 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,467.37 / $5,623.41
| Professional | | $1,288.25 | $3,467.37 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,344.23 / $2,344.23
| Professional | | $2,344.23 | $2,344.23 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,981.07 / $4,677.35
| Professional | | $1,288.25 | $3,981.07 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $13,803.84 / $17,782.79
| Facility | | $8,912.51 | $13,803.84 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,071.52 / $2,951.21
| Professional | | $691.83 | $1,071.52 | $2,951.21 |