- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $5,011.87 / $8,317.64
| Facility | | $1,202.26 | $5,011.87 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,023.29 / $2,630.27
| Professional | | $707.95 | $1,023.29 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $6,760.83 / $7,413.10
| Facility | | $5,888.44 | $6,760.83 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,258.93 / $1,778.28
| Professional | | $831.76 | $1,258.93 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $4,466.84 / $10,000.00
| Professional | | $870.96 | $4,466.84 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,023.29 / $1,698.24
| Professional | | $724.44 | $1,023.29 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $933.25 / $1,202.26
| Professional | | $794.33 | $933.25 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,000.00 / $1,096.48
| Professional | | $954.99 | $1,000.00 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,047.13 / $1,659.59
| Facility | | $776.25 | $1,047.13 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,071.52 / $10,000.00
| Facility | | $707.95 | $1,071.52 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,071.52 / $10,000.00
| Professional | | $707.95 | $1,071.52 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $9,549.93 / $19,054.61
| Facility | | $5,623.41 | $9,549.93 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $831.76 / $1,513.56
| Professional | | $575.44 | $831.76 | $1,513.56 |