- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,778.28 / $8,709.64
| Facility | | $1,122.02 | $1,778.28 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,258.93 / $2,884.03
| Professional | | $1,023.29 | $1,258.93 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,412.54 / $2,818.38
| Professional | | $1,096.48 | $1,412.54 | $2,818.38 |
- 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
- $977.24 / $1,479.11 / $2,691.53
| Professional | | $977.24 | $1,479.11 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,584.89 / $1,584.89
| Professional | | $1,584.89 | $1,584.89 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,348.96 / $2,137.96
| Facility | | $1,047.13 | $1,348.96 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,023.29 / $1,023.29
| Professional | | $1,023.29 | $1,023.29 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $2,089.30 / $2,884.03
| Professional | | $891.25 | $2,089.30 | $2,884.03 |
- 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
- $912.01 / $1,202.26 / $2,187.76
| Professional | | $912.01 | $1,202.26 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $7,943.28 / $7,943.28
| Facility | | $56.23 | $7,943.28 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,317.64 / $8,317.64 / $10,000.00
| Professional | | $8,317.64 | $8,317.64 | $10,000.00 |