- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $5,011.87 / $12,589.25
| Facility | | $933.25 | $5,011.87 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $741.31 / $1,122.02
| Professional | | $426.58 | $741.31 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $331.13 / $331.13
| Professional | | $331.13 | $331.13 | $331.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $5,128.61 / $10,000.00
| Facility | | $3,890.45 | $5,128.61 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $707.95 / $1,023.29
| Professional | | $416.87 | $707.95 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $1,071.52 / $1,445.44
| Professional | | $501.19 | $1,071.52 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $1,047.13 / $7,943.28
| Facility | | $457.09 | $1,047.13 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $977.24 / $3,890.45
| Professional | | $616.60 | $977.24 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,122.02 / $1,445.44
| Professional | | $1,023.29 | $1,122.02 | $1,445.44 |
- 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
- $3.02 / $870.96 / $1,148.15
| Professional | | $3.02 | $870.96 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $5,370.32 / $8,128.31
| Facility | | $3,630.78 | $5,370.32 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $912.01 / $1,202.26
| Professional | | $630.96 | $912.01 | $1,202.26 |