- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,715.35 / $5,888.44
| Facility | | $2,691.53 | $3,715.35 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,248.07 / $5,888.44 / $15,848.93
| Professional | | $5,248.07 | $5,888.44 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,548.13 / $18,197.01
| Facility | | $56.23 | $3,548.13 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,786.30 / $8,128.31 / $39,810.72
| Professional | | $4,786.30 | $8,128.31 | $39,810.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,317.64 / $10,964.78 / $14,454.40
| Professional | | $8,317.64 | $10,964.78 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $10,471.29 / $19,952.62
| Professional | | $2,691.53 | $10,471.29 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $6,918.31 / $9,772.37
| Facility | | $302.00 | $6,918.31 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,025.60 / $7,413.10 / $11,748.98
| Professional | | $6,025.60 | $7,413.10 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,311.31 / $5,888.44
| Facility | | $1,000.00 | $3,311.31 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,495.41 / $9,772.37 / $14,454.40
| Professional | | $5,495.41 | $9,772.37 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $3,548.13 / $18,197.01
| Facility | | $56.23 | $3,548.13 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,786.30 / $8,128.31 / $39,810.72
| Professional | | $4,786.30 | $8,128.31 | $39,810.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,311.31 / $5,754.40
| Facility | | $1,000.00 | $3,311.31 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,456.54 / $8,317.64 / $16,218.10
| Professional | | $6,456.54 | $8,317.64 | $16,218.10 |