- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $5,495.41 / $14,454.40
| Facility | | $1,230.27 | $5,495.41 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $1,862.09 / $12,022.64
| Professional | | $501.19 | $1,862.09 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $10,000.00 / $18,620.87
| Facility | | $4,365.16 | $10,000.00 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $6,918.31 / $10,471.29
| Professional | | $851.14 | $6,918.31 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $4,168.69 / $4,265.80
| Facility | | $4,168.69 | $4,168.69 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $977.24 / $10,964.78
| Professional | | $575.44 | $977.24 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $4,786.30 / $14,791.08
| Facility | | $758.58 | $4,786.30 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $5,495.41 / $13,489.63
| Professional | | $776.25 | $5,495.41 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $16,218.10 / $22,908.68
| Facility | | $12,882.50 | $16,218.10 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $2,884.03 / $13,489.63
| Professional | | $831.76 | $2,884.03 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $5,370.32 / $13,489.63
| Professional | | $776.25 | $5,370.32 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $11,748.98 / $51,286.14
| Facility | | $2,570.40 | $11,748.98 | $51,286.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $5,495.41 / $12,589.25
| Professional | | $588.84 | $5,495.41 | $12,589.25 |