- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,715.35 / $4,786.30
| Facility | | $1,445.44 | $3,715.35 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,513.56 / $2,238.72
| Professional | | $1,288.25 | $1,513.56 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $10,232.93 / $12,022.64
| Facility | | $7,762.47 | $10,232.93 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $33.11 / $58.88
| Professional | | $33.11 | $33.11 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,584.89 / $1,737.80
| Professional | | $1,479.11 | $1,584.89 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $3,801.89 / $10,000.00
| Facility | | $1,995.26 | $3,801.89 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,344.23 / $2,818.38
| Professional | | $2,344.23 | $2,344.23 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,137.96 / $2,691.53
| Professional | | $1,949.84 | $2,137.96 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,862.09 / $3,019.95
| Facility | | $1,445.44 | $1,862.09 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,258.93 / $4,073.80
| Professional | | $1,258.93 | $1,258.93 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,238.72 / $3,981.07
| Facility | | $1,348.96 | $2,238.72 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,290.87 / $3,981.07
| Professional | | $1,348.96 | $2,290.87 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,949.84 / $2,344.23
| Facility | | $1,174.90 | $1,949.84 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $977.24 / $2,238.72
| Professional | | $812.83 | $977.24 | $2,238.72 |