- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $3,801.89 / $8,128.31
| Facility | | $645.65 | $3,801.89 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $588.84 / $1,258.93
| Professional | | $398.11 | $588.84 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,248.07 / $57,543.99
| Facility | | $5,011.87 | $5,248.07 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $616.60 / $660.69
| Professional | | $489.78 | $616.60 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $741.31 / $741.31
| Facility | | $741.31 | $741.31 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $602.56 / $1,096.48
| Professional | | $416.87 | $602.56 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,000.00 / $1,258.93
| Professional | | $724.44 | $1,000.00 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $630.96 / $1,023.29
| Professional | | $407.38 | $630.96 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $6,918.31 / $13,489.63
| Facility | | $1,621.81 | $6,918.31 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $446.68 / $512.86
| Professional | | $436.52 | $446.68 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $3,630.78 / $7,762.47
| Facility | | $660.69 | $3,630.78 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $660.69 / $1,513.56
| Professional | | $426.58 | $660.69 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $524.81 / $1,258.93
| Facility | | $524.81 | $524.81 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $676.08 / $1,318.26
| Professional | | $549.54 | $676.08 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $467.74 / $501.19
| Facility | | $426.58 | $467.74 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $467.74 / $575.44
| Professional | | $426.58 | $467.74 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $3,548.13 / $10,000.00
| Facility | | $1,348.96 | $3,548.13 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $588.84 / $1,000.00
| Professional | | $416.87 | $588.84 | $1,000.00 |