- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $5,011.87 / $14,125.38
| Facility | | $1,000.00 | $5,011.87 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $5,128.61 / $9,332.54
| Professional | | $457.09 | $5,128.61 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $4,677.35 / $5,754.40
| Professional | | $537.03 | $4,677.35 | $5,754.40 |
- 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
- $457.09 / $6,025.60 / $8,317.64
| Professional | | $457.09 | $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
- $562.34 / $851.14 / $9,549.93
| Professional | | $562.34 | $851.14 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $5,248.07 / $13,182.57
| Facility | | $501.19 | $5,248.07 | $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
- $426.58 / $4,466.84 / $9,120.11
| Professional | | $426.58 | $4,466.84 | $9,120.11 |