- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $7,943.28 / $13,182.57
| Facility | | $1,023.29 | $7,943.28 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $5,370.32 / $15,135.61
| Professional | | $489.78 | $5,370.32 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,489.63 / $13,489.63 / $13,489.63
| Professional | | $13,489.63 | $13,489.63 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $8,709.64 / $16,982.44
| Facility | | $6,606.93 | $8,709.64 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $4,570.88 / $10,471.29
| Professional | | $562.34 | $4,570.88 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $5,495.41
| Facility | | $5,495.41 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $7,079.46 / $16,218.10
| Professional | | $954.99 | $7,079.46 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $8,128.31 / $11,220.18
| Facility | | $602.56 | $8,128.31 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,244.36 / $13,182.57 / $20,892.96
| Professional | | $7,244.36 | $13,182.57 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $10,471.29 / $18,197.01
| Professional | | $1,122.02 | $10,471.29 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $5,495.41
| Facility | | $5,495.41 | $5,495.41 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,737.80 / $18,197.01
| Professional | | $1,096.48 | $1,737.80 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $8,511.38 / $10,000.00
| Facility | | $6,918.31 | $8,511.38 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $6,309.57 / $16,218.10
| Professional | | $630.96 | $6,309.57 | $16,218.10 |