- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,388.44 / $5,623.41
| Facility | | $2,137.96 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,137.96 / $6,025.60
| Professional | | $1,513.56 | $2,137.96 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,388.44 / $43,651.58
| Facility | | $1,000.00 | $3,388.44 | $43,651.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,570.40 / $57,543.99
| Professional | | $1,023.29 | $2,570.40 | $57,543.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,964.78 / $10,964.78 / $12,882.50
| Professional | | $10,964.78 | $10,964.78 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,311.31 / $5,888.44
| Facility | | $1,000.00 | $3,311.31 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,943.28 / $10,232.93 / $20,892.96
| Professional | | $7,943.28 | $10,232.93 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,467.37 / $43,651.58
| Facility | | $1,023.29 | $3,467.37 | $43,651.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,570.40 / $57,543.99
| Professional | | $1,023.29 | $2,570.40 | $57,543.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,884.03 / $4,677.35
| Facility | | $954.99 | $2,884.03 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $2,951.21 / $20,417.38
| Professional | | $1,047.13 | $2,951.21 | $20,417.38 |