- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,715.35 / $5,623.41
| Facility | | $2,691.53 | $3,715.35 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,488.17 / $15,488.17 / $15,488.17
| Professional | | $15,488.17 | $15,488.17 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $6,760.83 / $20,417.38
| Facility | | $2,691.53 | $6,760.83 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,000.00 / $10,000.00 / $10,000.00
| Professional | | $10,000.00 | $10,000.00 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $6,918.31 / $20,417.38
| Facility | | $2,691.53 | $6,918.31 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,892.96 / $37,153.52 / $52,480.75
| Professional | | $20,892.96 | $37,153.52 | $52,480.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $6,918.31 / $20,417.38
| Facility | | $3,311.31 | $6,918.31 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $7,244.36 / $33,884.42
| Facility | | $2,691.53 | $7,244.36 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,498.45 / $25,703.96 / $47,863.01
| Professional | | $19,498.45 | $25,703.96 | $47,863.01 |