- 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
- $363.08 / $1,148.15 / $2,041.74
| Professional | | $363.08 | $1,148.15 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $4,677.35 / $6,309.57
| Facility | | $3,467.37 | $4,677.35 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $1,000.00 / $2,818.38
| Professional | | $309.03 | $1,000.00 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,905.46 / $3,890.45
| Professional | | $691.83 | $1,905.46 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $10,000.00 / $10,000.00
| Facility | | $10,000.00 | $10,000.00 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $1,318.26 / $3,162.28
| Professional | | $371.54 | $1,318.26 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $10,000.00 / $10,000.00
| Facility | | $10,000.00 | $10,000.00 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $1,862.09 / $4,570.88
| Professional | | $524.81 | $1,862.09 | $4,570.88 |