- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $5,888.44 / $8,511.38
| Facility | | $1,000.00 | $5,888.44 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $1,122.02 / $8,709.64
| Professional | | $467.74 | $1,122.02 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $630.96 / $5,888.44
| Professional | | $630.96 | $630.96 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,703.96 / $39,810.72 / $64,565.42
| Facility | | $25,703.96 | $39,810.72 | $64,565.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $6,025.60 / $8,317.64
| Professional | | $489.78 | $6,025.60 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $5,623.41 / $5,623.41
| Facility | | $5,623.41 | $5,623.41 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $912.01 / $9,772.37
| Professional | | $602.56 | $912.01 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $5,495.41 / $13,182.57
| Facility | | $537.03 | $5,495.41 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,495.41 / $7,762.47 / $52,480.75
| Professional | | $5,495.41 | $7,762.47 | $52,480.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $8,128.31 / $15,135.61
| Facility | | $1,949.84 | $8,128.31 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $4,466.84 / $9,120.11
| Professional | | $457.09 | $4,466.84 | $9,120.11 |