- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $4,466.84 / $5,495.41
| Facility | | $1,412.54 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $954.99 / $2,511.89
| Professional | | $151.36 | $954.99 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $4,466.84 / $10,000.00
| Facility | | $1,023.29 | $4,466.84 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $1,479.11 / $2,137.96
| Professional | | $173.78 | $1,479.11 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $870.96 / $2,089.30
| Professional | | $181.97 | $870.96 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.49 / $1,122.02 / $4,466.84
| Facility | | $117.49 | $1,122.02 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $323.59 / $2,290.87
| Professional | | $109.65 | $323.59 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $8,709.64 / $12,302.69
| Facility | | $6,918.31 | $8,709.64 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $309.03 / $2,290.87
| Professional | | $218.78 | $309.03 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $1,047.13 / $7,079.46
| Professional | | $223.87 | $1,047.13 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $9,332.54 / $18,197.01
| Facility | | $1,412.54 | $9,332.54 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $1,000.00 / $2,187.76
| Professional | | $186.21 | $1,000.00 | $2,187.76 |