- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $5,248.07 / $9,772.37
| Facility | | $1,778.28 | $5,248.07 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $1,318.26 / $2,884.03
| Professional | | $114.82 | $1,318.26 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $2,187.76 / $2,630.27 / $3,801.89
| Professional | 50 | $2,187.76 | $2,630.27 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,122.02 / $1,513.56
| Professional | | $831.76 | $1,122.02 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,570.40 / $4,897.79
| Facility | | $1,230.27 | $2,570.40 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $1,047.13 / $1,621.81
| Professional | | $102.33 | $1,047.13 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $1,621.81
| Facility | | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $363.08 / $2,630.27
| Professional | | $147.91 | $363.08 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $1,202.26 / $3,235.94
| Facility | | $134.90 | $1,202.26 | $3,235.94 |
- 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
- $1,698.24 / $6,760.83 / $10,000.00
| Facility | | $1,698.24 | $6,760.83 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $1,096.48 / $2,951.21
| Professional | | $123.03 | $1,096.48 | $2,951.21 |