- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $7,943.28 / $13,489.63
| Facility | | $954.99 | $7,943.28 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $5,248.07 / $18,620.87
| Professional | | $457.09 | $5,248.07 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $4,677.35 / $7,079.46
| Professional | | $851.14 | $4,677.35 | $7,079.46 |
- 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
- $524.81 / $4,570.88 / $10,471.29
| Professional | | $524.81 | $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
- $891.25 / $7,079.46 / $15,488.17
| Professional | | $891.25 | $7,079.46 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $6,606.93 / $11,220.18
| Facility | | $562.34 | $6,606.93 | $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
- $1,047.13 / $10,232.93 / $18,197.01
| Professional | | $1,047.13 | $10,232.93 | $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
- $1,023.29 / $1,621.81 / $18,197.01
| Professional | | $1,023.29 | $1,621.81 | $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
- $588.84 / $6,309.57 / $16,218.10
| Professional | | $588.84 | $6,309.57 | $16,218.10 |