- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $4,897.79 / $10,471.29
| Facility | | $2,137.96 | $4,897.79 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,202.26 / $2,238.72
| Professional | | $1,000.00 | $1,202.26 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $12,022.64 / $13,803.84
| Facility | | $6,760.83 | $12,022.64 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $2,137.96 / $2,951.21
| Professional | | $1,071.52 | $2,137.96 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $16,218.10 / $16,218.10
| Facility | | $1,000.00 | $16,218.10 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,659.59 / $3,467.37
| Professional | | $977.24 | $1,659.59 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,778.28 / $2,187.76
| Professional | | $1,348.96 | $1,778.28 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $4,786.30 / $10,000.00
| Facility | | $758.58 | $4,786.30 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,479.11 / $3,311.31
| Professional | | $1,000.00 | $1,479.11 | $3,311.31 |