- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $7,585.78 / $13,489.63
| Facility | | $5,248.07 | $7,585.78 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,737.80 / $4,786.30
| Professional | | $1,000.00 | $1,737.80 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $10,471.29 / $20,417.38
| Facility | | $7,943.28 | $10,471.29 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,698.24 / $2,398.83
| Professional | | $1,023.29 | $1,698.24 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $10,232.93 / $10,232.93
| Facility | | $10,232.93 | $10,232.93 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $2,454.71 / $3,162.28
| Professional | | $1,174.90 | $2,454.71 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,778.28 / $19,054.61
| Facility | | $1,000.00 | $1,778.28 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,995.26 / $8,128.31
| Professional | | $1,148.15 | $1,995.26 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,511.89 / $3,388.44
| Professional | | $2,089.30 | $2,511.89 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $10,232.93 / $10,232.93
| Facility | | $10,232.93 | $10,232.93 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,511.89 / $3,388.44
| Professional | | $2,398.83 | $2,511.89 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $8,912.51 / $16,982.44
| Facility | | $6,309.57 | $8,912.51 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,949.84 / $2,754.23
| Professional | | $1,148.15 | $1,949.84 | $2,754.23 |