- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,715.35 / $5,623.41
| Facility | | $2,691.53 | $3,715.35 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,981.07 / $8,912.51
| Professional | | $3,467.37 | $3,981.07 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $2,818.38 / $43,651.58
| Facility | | $812.83 | $2,818.38 | $43,651.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $5,370.32 / $26,302.68
| Professional | | $3,467.37 | $5,370.32 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $676.08 / $741.31
| Facility | | $50.12 | $676.08 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $5,128.61 / $10,000.00
| Professional | | $1,230.27 | $5,128.61 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $4,897.79 / $8,511.38
| Facility | | $302.00 | $4,897.79 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $5,128.61 / $7,585.78
| Professional | | $3,630.78 | $5,128.61 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $2,454.71 / $4,677.35
| Facility | | $295.12 | $2,454.71 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $6,309.57 / $9,549.93
| Professional | | $3,548.13 | $6,309.57 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $2,818.38 / $43,651.58
| Facility | | $812.83 | $2,818.38 | $43,651.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $5,370.32 / $26,302.68
| Professional | | $3,548.13 | $5,370.32 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,754.23 / $4,677.35
| Facility | | $794.33 | $2,754.23 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,630.78 / $5,623.41 / $10,471.29
| Professional | | $3,630.78 | $5,623.41 | $10,471.29 |