- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $2,344.23 / $2,344.23
| Facility | | $229.09 | $2,344.23 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $1,122.02 / $3,311.31
| Professional | | $218.78 | $1,122.02 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $12,882.50 / $38,904.51
| Facility | | $7,244.36 | $12,882.50 | $38,904.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $1,584.89 / $5,888.44
| Professional | | $363.08 | $1,584.89 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $7,585.78 / $18,197.01
| Facility | | $4,786.30 | $7,585.78 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $3,311.31 / $8,317.64
| Professional | | $489.78 | $3,311.31 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $7,244.36 / $14,125.38
| Facility | | $5,888.44 | $7,244.36 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $2,754.23 / $7,943.28
| Professional | | $457.09 | $2,754.23 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $3,981.07 / $12,022.64
| Facility | | $354.81 | $3,981.07 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $5,128.61 / $10,232.93
| Professional | | $2,951.21 | $5,128.61 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $10,000.00 / $14,125.38
| Facility | | $1,584.89 | $10,000.00 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $2,238.72 / $7,585.78
| Professional | | $331.13 | $2,238.72 | $7,585.78 |