- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $7,244.36 / $16,595.87
| Facility | | $2,884.03 | $7,244.36 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $1,000.00 / $2,884.03
| Professional | | $89.13 | $1,000.00 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,888.44 / $5,888.44 / $5,888.44
| Professional | | $5,888.44 | $5,888.44 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $2,884.03 / $4,897.79
| Facility | | $549.54 | $2,884.03 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $3,235.94 / $6,606.93
| Professional | | $83.18 | $3,235.94 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $1,621.81
| Facility | | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,981.07 / $3,981.07 / $3,981.07
| Professional | | $3,981.07 | $3,981.07 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $89.13 / $1,000.00 / $3,890.45
| Facility | | $89.13 | $1,000.00 | $3,890.45 |
- 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
- $380.19 / $1,230.27 / $4,677.35
| Facility | | $380.19 | $1,230.27 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $1,202.26 / $2,818.38
| Professional | | $81.28 | $1,202.26 | $2,818.38 |