- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $5,011.87 / $12,589.25
| Facility | | $2,344.23 | $5,011.87 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $851.14 / $5,623.41
| Professional | | $380.19 | $851.14 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $380.19 / $2,187.76
| Professional | | $338.84 | $380.19 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,791.08 / $18,620.87 / $38,018.94
| Facility | | $14,791.08 | $18,620.87 | $38,018.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $1,862.09 / $4,365.16
| Professional | | $478.63 | $1,862.09 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $7,585.78 / $7,585.78
| Facility | | $7,585.78 | $7,585.78 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,621.81 / $5,370.32
| Professional | | $660.69 | $1,621.81 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $2,137.96 / $8,128.31
| Facility | | $478.63 | $2,137.96 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $380.19 / $380.19 / $380.19
| Facility | 53 | $380.19 | $380.19 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $3,467.37 / $16,982.44
| Professional | | $1,659.59 | $3,467.37 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $3,715.35 / $5,248.07
| Professional | | $794.33 | $3,715.35 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $7,585.78 / $7,585.78
| Facility | | $7,585.78 | $7,585.78 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,288.25 / $7,413.10
| Professional | | $912.01 | $1,288.25 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $8,128.31 / $10,000.00
| Facility | | $6,918.31 | $8,128.31 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $1,659.59 / $4,677.35
| Professional | | $512.86 | $1,659.59 | $4,677.35 |