- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $3,388.44 / $5,623.41
| Facility | | $776.25 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $977.24 / $2,041.74
| Professional | | $741.31 | $977.24 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,754.23 / $6,456.54
| Facility | | $56.23 | $2,754.23 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,174.90 / $2,818.38
| Professional | | $691.83 | $1,174.90 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $954.99 / $2,187.76
| Facility | | $954.99 | $954.99 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,659.59 / $2,290.87
| Professional | | $954.99 | $1,659.59 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $645.65 / $645.65
| Facility | | $645.65 | $645.65 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,548.82 / $2,818.38
| Professional | | $776.25 | $1,548.82 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,548.82 / $7,079.46
| Facility | | $575.44 | $1,548.82 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,288.25 / $1,737.80
| Professional | | $1,000.00 | $1,288.25 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,981.07 / $9,772.37
| Facility | | $1,698.24 | $3,981.07 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,288.25 / $2,454.71
| Professional | | $851.14 | $1,288.25 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,380.38 / $1,412.54
| Professional | | $1,348.96 | $1,380.38 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,884.03 / $6,606.93
| Facility | | $56.23 | $2,884.03 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,148.15 / $2,818.38
| Professional | | $691.83 | $1,148.15 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,981.07 / $9,120.11
| Facility | | $1,698.24 | $3,981.07 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,174.90 / $2,454.71
| Professional | | $812.83 | $1,174.90 | $2,454.71 |