- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $4,570.88 / $7,762.47
| Facility | | $2,570.40 | $4,570.88 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $2,818.38 / $9,549.93
| Professional | | $741.31 | $2,818.38 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $7,413.10 / $50,118.72
| Facility | | $1,819.70 | $7,413.10 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $3,162.28 / $18,197.01
| Professional | | $831.76 | $3,162.28 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $2,089.30
| Facility | | $891.25 | $891.25 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $2,818.38 / $16,982.44
| Professional | | $954.99 | $2,818.38 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $1,479.11 / $7,079.46
| Facility | | $691.83 | $1,479.11 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $5,754.40 / $10,000.00
| Professional | | $3,311.31 | $5,754.40 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $6,918.31 / $30,902.95
| Facility | | $2,691.53 | $6,918.31 | $30,902.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $5,888.44 / $14,791.08
| Professional | | $831.76 | $5,888.44 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $10,471.29 / $50,118.72
| Facility | | $1,819.70 | $10,471.29 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $2,818.38 / $17,782.79
| Professional | | $831.76 | $2,818.38 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $7,244.36 / $30,902.95
| Facility | | $2,691.53 | $7,244.36 | $30,902.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,290.87 / $15,848.93
| Professional | | $1,000.00 | $2,290.87 | $15,848.93 |