- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $5,011.87 / $10,964.78
| Facility | | $1,202.26 | $5,011.87 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $562.34 / $1,380.38
| Professional | | $245.47 | $562.34 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $263.03 / $263.03
| Professional | | $263.03 | $263.03 | $263.03 |
- 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
- $295.12 / $537.03 / $1,148.15
| Professional | | $295.12 | $537.03 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $741.31 / $1,584.89
| Professional | | $295.12 | $741.31 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $954.99 / $5,754.40
| Facility | | $302.00 | $954.99 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,230.27 / $9,120.11
| Professional | | $741.31 | $1,230.27 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $1,202.26 / $1,584.89
| Professional | | $616.60 | $1,202.26 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $1,258.93
| Professional | | $575.44 | $575.44 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $977.24 / $1,659.59
| Professional | | $5.01 | $977.24 | $1,659.59 |
- 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
- $354.81 / $724.44 / $1,380.38
| Professional | | $354.81 | $724.44 | $1,380.38 |