- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $7,585.78 / $12,022.64
| Facility | | $1,819.70 | $7,585.78 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,071.52 / $6,309.57
| Professional | | $891.25 | $1,071.52 | $6,309.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $6,918.31 / $15,135.61
| Facility | | $2,238.72 | $6,918.31 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,071.52 / $1,862.09
| Professional | | $870.96 | $1,071.52 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $954.99 / $1,071.52
| Facility | | $891.25 | $954.99 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,230.27 / $21,379.62
| Facility | | $794.33 | $1,230.27 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $1,258.93 / $1,905.46
| Professional | | $457.09 | $1,258.93 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $1,230.27 / $1,905.46
| Professional | | $457.09 | $1,230.27 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,023.29 / $1,949.84
| Professional | | $870.96 | $1,023.29 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $3,090.30 / $6,760.83
| Facility | | $1,479.11 | $3,090.30 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,122.02 / $1,778.28
| Professional | | $831.76 | $1,122.02 | $1,778.28 |