- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $8,128.31 / $10,000.00
| Facility | | $5,495.41 | $8,128.31 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,511.89 / $5,248.07 / $12,302.69
| Professional | | $2,511.89 | $5,248.07 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,570.88 / $8,317.64 / $12,022.64
| Professional | | $4,570.88 | $8,317.64 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,801.89 / $8,317.64 / $10,232.93
| Professional | | $3,801.89 | $8,317.64 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $5,623.41 / $11,748.98
| Facility | | $3,235.94 | $5,623.41 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,818.38 / $8,128.31 / $12,882.50
| Professional | | $2,818.38 | $8,128.31 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $7,762.47 / $8,317.64
| Facility | | $3,715.35 | $7,762.47 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $5,495.41 / $10,000.00
| Facility | | $3,467.37 | $5,495.41 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $7,585.78 / $11,220.18
| Professional | | $79.43 | $7,585.78 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,877.62 / $21,877.62 / $21,877.62
| Facility | | $21,877.62 | $21,877.62 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,585.78 / $9,549.93 / $12,882.50
| Professional | | $7,585.78 | $9,549.93 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $10,232.93 / $37,153.52
| Facility | | $2,454.71 | $10,232.93 | $37,153.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,370.32 / $8,511.38 / $12,022.64
| Professional | | $5,370.32 | $8,511.38 | $12,022.64 |