- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $7,943.28 / $20,892.96
| Facility | | $1,584.89 | $7,943.28 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $933.25 / $2,344.23
| Professional | | $724.44 | $933.25 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,548.82 / $2,511.89
| Professional | | $954.99 | $1,548.82 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,949.84 / $13,803.84
| Facility | | $1,096.48 | $1,949.84 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,819.70 / $5,495.41
| Professional | | $1,071.52 | $1,819.70 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $56.23
| Professional | | $32.36 | $33.11 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,584.89 / $1,698.24
| Facility | | $1,288.25 | $1,584.89 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,148.15 / $1,148.15
| Facility | | $1,122.02 | $1,148.15 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,905.46 / $2,454.71
| Professional | | $1,148.15 | $1,905.46 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $14,125.38 / $26,915.35
| Facility | | $10,000.00 | $14,125.38 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,621.81 / $2,187.76
| Professional | | $1,148.15 | $1,621.81 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $17,782.79 / $30,199.52
| Facility | | $3,467.37 | $17,782.79 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,318.26 / $2,344.23
| Professional | | $812.83 | $1,318.26 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,000.00 / $1,380.38
| Professional | | $741.31 | $1,000.00 | $1,380.38 |