- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,466.84 / $5,495.41
| Facility | | $2,884.03 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,000.00 / $1,258.93
| Professional | | $891.25 | $1,000.00 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $4,073.80 / $13,489.63
| Facility | | $1,659.59 | $4,073.80 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $616.60 / $1,148.15
| Professional | | $524.81 | $616.60 | $1,148.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $2,884.03 / $7,762.47
| Facility | | $891.25 | $2,884.03 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $954.99 / $1,318.26
| Professional | | $891.25 | $954.99 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Professional | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $10,000.00 / $16,595.87
| Facility | | $5,495.41 | $10,000.00 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,548.82 / $5,011.87
| Professional | | $1,148.15 | $1,548.82 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $616.60 / $13,182.57
| Professional | | $616.60 | $616.60 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $5,495.41 / $12,302.69
| Facility | | $1,148.15 | $5,495.41 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,348.96 / $1,862.09
| Professional | | $1,047.13 | $1,348.96 | $1,862.09 |