- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $5,623.41 / $8,709.64
| Facility | | $2,454.71 | $5,623.41 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,122.02 / $3,890.45
| Professional | | $933.25 | $1,122.02 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $5,011.87 / $10,000.00
| Facility | | $2,238.72 | $5,011.87 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,202.26 / $1,905.46
| Professional | | $954.99 | $1,202.26 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $977.24 / $1,445.44
| Professional | | $912.01 | $977.24 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,258.93 / $2,089.30
| Professional | | $831.76 | $1,258.93 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $2,691.53 / $26,302.68
| Facility | | $1,047.13 | $2,691.53 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,479.11 / $10,000.00
| Professional | | $954.99 | $1,479.11 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,890.45 / $7,943.28
| Facility | | $2,454.71 | $3,890.45 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,288.25 / $2,398.83
| Professional | | $891.25 | $1,288.25 | $2,398.83 |