- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,754.23 / $11,481.54
| Facility | | $2,398.83 | $2,754.23 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $524.81 / $3,548.13
| Professional | | $144.54 | $524.81 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $10,000.00 / $18,197.01
| Facility | | $8,912.51 | $10,000.00 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $338.84 / $3,162.28
| Professional | | $123.03 | $338.84 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $186.21 / $512.86 / $4,677.35
| Professional | 50 | $186.21 | $512.86 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $446.68 / $4,786.30
| Professional | | $199.53 | $446.68 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $9,549.93 / $9,549.93
| Facility | | $9,549.93 | $9,549.93 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $1,698.24 / $3,890.45
| Professional | | $147.91 | $1,698.24 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $9,549.93 / $9,549.93
| Facility | | $9,549.93 | $9,549.93 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $1,737.80 / $6,165.95
| Professional | | $194.98 | $1,737.80 | $6,165.95 |