- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $6,309.57 / $10,964.78
| Facility | | $1,412.54 | $6,309.57 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $1,380.38 / $2,454.71
| Professional | | $295.12 | $1,380.38 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $10,000.00 / $57,543.99
| Facility | | $9,549.93 | $10,000.00 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $2,137.96 / $2,951.21
| Professional | | $1,174.90 | $2,137.96 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $602.56 / $3,019.95
| Professional | | $302.00 | $602.56 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,290.87 / $2,398.83
| Professional | | $2,290.87 | $2,290.87 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $2,137.96 / $3,801.89
| Professional | | $371.54 | $2,137.96 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $5,370.32 / $10,471.29
| Facility | | $1,047.13 | $5,370.32 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $1,412.54 / $3,630.78
| Professional | | $309.03 | $1,412.54 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $3,801.89 / $4,365.16
| Professional | | $5.01 | $3,801.89 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $3,801.89
| Facility | | $501.19 | $501.19 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $3,801.89
| Professional | | $501.19 | $501.19 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,981.07 / $9,772.37
| Facility | | $2,089.30 | $3,981.07 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $1,174.90 / $3,090.30
| Professional | | $288.40 | $1,174.90 | $3,090.30 |