- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $4,265.80 / $7,762.47
| Facility | | $2,187.76 | $4,265.80 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,041.74 / $2,290.87
| Professional | | $1,513.56 | $2,041.74 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,388.44 / $29,512.09
| Facility | | $1,000.00 | $3,388.44 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,630.78 / $16,982.44
| Professional | | $2,398.83 | $3,630.78 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $15,848.93 / $21,877.62
| Facility | | $7,762.47 | $15,848.93 | $21,877.62 |
- 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
- $3,235.94 / $3,235.94 / $3,801.89
| Professional | | $3,235.94 | $3,235.94 | $3,801.89 |
- 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
- $2,398.83 / $3,388.44 / $6,456.54
| Professional | | $2,398.83 | $3,388.44 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,467.37 / $29,512.09
| Facility | | $1,023.29 | $3,467.37 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,630.78 / $16,982.44
| Professional | | $2,398.83 | $3,630.78 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,884.03 / $4,677.35
| Facility | | $1,000.00 | $2,884.03 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $3,388.44 / $6,918.31
| Professional | | $2,511.89 | $3,388.44 | $6,918.31 |