- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,761.67 / $3,706.14 / $8,247.00
| Facility | | $1,761.67 | $3,706.14 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,664.25 / $1,866.04 / $3,006.37
| Professional | | $1,664.25 | $1,866.04 | $3,006.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,493.39 / $7,244.49 / $11,791.03
| Facility | | $2,493.39 | $7,244.49 | $11,791.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,811.57 / $4,769.29 / $5,866.50
| Facility | | $3,811.57 | $4,769.29 | $5,866.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,253.00 / $3,483.50 / $7,101.81
| Facility | | $2,253.00 | $3,483.50 | $7,101.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65.90 / $100.00 / $6,424.97
| Facility | | $65.90 | $100.00 | $6,424.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.34 / $558.24 / $626.76
| Professional | | $329.34 | $558.24 | $626.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,606.57 / $1,893.98 / $2,359.66
| Professional | | $1,606.57 | $1,893.98 | $2,359.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $100.00
| Professional | | $40.00 | $40.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,120.34 / $2,120.34 / $3,912.08
| Facility | | $2,120.34 | $2,120.34 | $3,912.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,118.62 / $6,710.25 / $8,387.81
| Professional | | $6,118.62 | $6,710.25 | $8,387.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $3,951.00 / $7,934.00
| Facility | | $1,981.00 | $3,951.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,852.70 / $2,644.24 / $4,360.80
| Professional | | $1,852.70 | $2,644.24 | $4,360.80 |