- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $8,709.64 / $17,378.01
| Facility | | $5,888.44 | $8,709.64 | $17,378.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,288.25 / $2,570.40
| Professional | | $1,000.00 | $1,288.25 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $954.99 / $1,995.26
| Professional | | $851.14 | $954.99 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $6,606.93 / $15,488.17
| Facility | | $2,691.53 | $6,606.93 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,288.25 / $2,691.53
| Professional | | $831.76 | $1,288.25 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,122.02 / $3,388.44
| Facility | | $1,122.02 | $1,122.02 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,412.54 / $2,290.87
| Professional | | $741.31 | $1,412.54 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,513.56 / $3,388.44
| Facility | | $1,000.00 | $1,513.56 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $17,378.01 / $25,703.96
| Facility | | $2,884.03 | $17,378.01 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,174.90 / $1,995.26
| Professional | | $870.96 | $1,174.90 | $1,995.26 |