- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,778.28 / $8,709.64
| Facility | | $1,096.48 | $1,778.28 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,230.27 / $2,238.72
| Professional | | $1,023.29 | $1,230.27 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,737.80 / $3,019.95
| Professional | | $1,380.38 | $1,737.80 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $575.44 / $35,481.34
| Facility | | $489.78 | $575.44 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,737.80 / $2,951.21
| Professional | | $1,148.15 | $1,737.80 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,344.23 / $2,344.23
| Professional | | $2,344.23 | $2,344.23 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,348.96 / $2,238.72
| Facility | | $1,071.52 | $1,348.96 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,318.26 / $1,318.26
| Professional | | $1,318.26 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $2,089.30 / $2,754.23
| Professional | | $12.02 | $2,089.30 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $1,819.70 / $6,309.57
| Facility | | $309.03 | $1,819.70 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,318.26 / $2,344.23
| Professional | | $1,000.00 | $1,318.26 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $16,218.10 / $16,218.10
| Facility | | $56.23 | $16,218.10 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,762.47 / $7,762.47 / $9,549.93
| Professional | | $7,762.47 | $7,762.47 | $9,549.93 |