- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $11,481.54 / $20,892.96
| Facility | | $11,481.54 | $11,481.54 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $9,772.37 / $14,454.40
| Professional | | $1,000.00 | $9,772.37 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,445.44 / $2,511.89
| Facility | | $954.99 | $1,445.44 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $954.99 / $954.99
| Professional | | $912.01 | $954.99 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $13,803.84 / $26,302.68
| Professional | | $1,698.24 | $13,803.84 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $11,481.54 / $20,892.96
| Facility | | $11,481.54 | $11,481.54 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,549.93 / $12,022.64 / $16,218.10
| Professional | | $9,549.93 | $12,022.64 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $5,495.41 / $16,595.87
| Professional | | $1,000.00 | $5,495.41 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $12,022.64 / $12,022.64
| Facility | | $6,025.60 | $12,022.64 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,011.87 / $7,244.36 / $12,022.64
| Professional | | $5,011.87 | $7,244.36 | $12,022.64 |