- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $9,772.37 / $29,512.09
| Facility | | $1,949.84 | $9,772.37 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $1,023.29 / $5,754.40
| Professional | | $380.19 | $1,023.29 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,778.28 / $10,000.00
| Professional | | $1,047.13 | $1,778.28 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $2,137.96 / $10,964.78
| Facility | | $436.52 | $2,137.96 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $2,238.72 / $9,772.37
| Professional | | $933.25 | $2,238.72 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,570.40 / $9,332.54
| Professional | | $1,659.59 | $2,570.40 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $1,202.26 / $10,000.00
| Facility | | $457.09 | $1,202.26 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $1,047.13 / $5,128.61
| Professional | | $60.26 | $1,047.13 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $2,570.40 / $9,120.11
| Professional | | $1,047.13 | $2,570.40 | $9,120.11 |