- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $11,481.54 / $26,302.68
| Facility | | $5,011.87 | $11,481.54 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,398.83 / $10,964.78
| Facility | | $1,000.00 | $2,398.83 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $19,054.61
| Professional | | $1,000.00 | $1,000.00 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $16,982.44 / $50,118.72
| Facility | | $5,754.40 | $16,982.44 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,620.87 / $19,952.62 / $20,417.38
| Professional | | $18,620.87 | $19,952.62 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,413.10 / $13,489.63 / $19,952.62
| Professional | | $7,413.10 | $13,489.63 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $16,982.44 / $75,857.76
| Facility | | $501.19 | $16,982.44 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,488.17 / $19,498.45 / $21,877.62
| Professional | | $15,488.17 | $19,498.45 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $10,000.00 / $27,542.29
| Professional | | $758.58 | $10,000.00 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $870.96 / $1,949.84
| Facility | | $562.34 | $870.96 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $10,715.19 / $18,620.87
| Professional | | $1,445.44 | $10,715.19 | $18,620.87 |